33606_GILGO, GEORGE_20030327

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GENERAL PERMIT
Previous permit #
[]New []Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
El Rules attached.
Applicant Name
Address //r* / JUc
City r',/-J State ZIP
Phone # O ��+�/- t �. Fax # (�)
Authorized Agent
Affected CW ❑ EW p PTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: CJ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / nc
Project Location: County is , i
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin ( U
Adj. Wtr. Body r 'C i 1 ( (C (nat' /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity r-,_
(Scale:
Pier (dock) length T _
Platform(s)
Finger pier(s) I
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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Shoreline Length
SAM not sure yes 'no
Sandbags: not sure yes no-
❑..
Moratorium: n/a yes no �� G •
Photos: yes no
t
Waiver Attached: yes no --
A building permit may be required by:
Notes/ Special Conditions
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River Basin rules.
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❑ See note
t.t , If (,t-, ,�
on back
`•r,
regarding
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
<----W7.—it Officer'sSigna rd
Issuip Date / f Expiration Date
Local Planningjurisdiction Rover File Name
i

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar- Pamlico River Basin Buffer Rules
�Neuse River Basin Buffer Rules
❑ Other:
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastaimanagement.net
Revised 10/05/01

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PAY TO THE -
ORDER Of
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Look for: Micro Print signature line. gray type and linework. First Citizens Bank logo on back. If not presentdo not cash.
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s ADJACENT RIPARLAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIB OA TLIFTIB OA THO USE)
I hereby certify that I own property adjacent to 4Fa'P&6�
(Name of Property Owner)
grope.-y Io td at 0 7" -1i0 I 7 n
(Lot. Block, Road, etc.)
on &TT<g- ;Q eK- , in ��r� "�� P.��G< e,) �� - , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposi.:; a_ that location,
and, I have no objections to his proposal. I understand that a pier/mooring
piIings/boatlii�Jboathouse must be set back a minimum distance or Fftee:t fer: from my area
of riparian access unless waived by me.
I dO nOt Wish to waive the setback requirement.
✓ I �Lo wish. to waive t�at setback recuirerne:7t.
DESCRIPTION AND/OR DRA,WrG OF PROPOSED DEVELOPMENT:
(To be ftlled in by individual proposing developmenr)
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Print or Type Name
Telephone Number
Date:

L ADJACENT RIPARLAN PROPERTY OWNER STATE -LENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSF)
I hereby certify that I own property adjacent to ��o,��� a16<5o 's
(Name of Property Owner)
property located at L .7— //off - ,�) P�
(Lot. Block, Road, etc.)
on Z 7-72i�-- IC C'&. , in z9R 162,I 1;� L 1 FFAA/ e cv cad N.C.
(Waterbodv) (Town and/or County)
He has described to me, as s`lown below, the developme - ! e is propcs:.� a_ that location,
and, I have no objections to his proposal. I understGnd tha_ a pier; mooring
puings/boardiftlboathouse must be se. back a minimum distance of fiitenn fey* ; - , `rorn my arG3
of riparian access unless waived by me. v
I do not wish to wale-. the setback requirement.
I d-Q wish to wa' ve tr.at setback requirement.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DE'vFLGPtirtiT:
(To be fzZled in by individual proposin; development)
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Date: _