34552_KOHL, CHIP_20030729

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❑CAMA / ❑ DREDGE & FILL j 4, :
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 15A NCAC
0 Rules attached.
Applicant Name C, p 1,(60 Project Location: County 11'/0 V 0-
Address l y �1 i r a P/1 V f Street Address/ State Road/ Lot #(s)
City I10 Vr> j cc State I"" ZIP C.` <1 PA -e
Phone # (,7) t{') 471 Fax #
Authorized Agent A, r,
Affected ❑ CW ❑ EW P PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA Qye /� Crit. Hab. yes / no
Subdivision
City ZIP I�{I�'j
Phone # ( ) River Basin AAA
Adj. Wtr. Body L- c l h f +t K._ (nat /man /unkn)
Closest Maj. Wtr. Body—,V Jr' 1'f
Type of Project/ Activity A e i • r ` v R, , r k y
J + r . 7. (Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
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17
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Oath Y
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Beach Bulldozing
Other
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Shoreline Length-
SAM not sure yes
Sandbags: not sure yes
Moratorium: n/a ye-
s
Photos: yes
Waiver Attached: yes eo
A buildingpermit may be required b
P Y 9 Y
Notes/ Special Conditions
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River Basin rules.
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) I I Check #
Permit Officer's Signature
7 2 9 C
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Issuing Date
Expiration Date
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Local Planningf urisdiction
Rover File Name

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 1) 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
[Y Neuse River Basin Buffer Rules
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 / 1-888ARCOAST
Fax:[phone]
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
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.nccoastalmanagement.net
Revised 10/05/01

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
fFOR A PIERfUNCOVERED BOAT Lln- -)
I her b:,; er..rt+fy t6aat I own pro-eriv udja ce„? d9
41(Ne of Property Owner)
r ra is $sty ;D c a i e d at
(Lot, Blois ,. Read, etc.)
anNC
__. _ ._ _w_ in �.s, 4� - : ,
erbody ._ (Town atsdior County)� ��
He has described to nee, as shown below, the developtneal he %-PrOrAiTiRg �ttl�e*i�rcaita, :
and I have no objections to his propwiaf, I a nderstap f thst a pieriuncovered beat lift Mutt be w4
bark st s minimum of Afteen (15') from my area of rip-swi*n access usYess Waived bV me.
CAM wish to waive tine att ICI requirement.
l _Q wish to waive lk a# setback requirement,
DE
SCR PTION AND/OR ]DRAWING OF PROPOSMDEVFI.,OPMVNT:
(To be fiticd in by individual proposing development)
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Telephone Number Da e
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ADJACENT RIPARIAN PROPERTY OWNER s'rATEMFN'F
(FOR A PIER./UNCOVERED BOAT LIVI)
I hereby certify that I own property adjacent to
of Property Owner)
property located at
(Lot, Block., Road, etc.) -- _._---_-_--
on < jl in NC
erbody) (Town and/or County
He has described to me, as shown below, the development he is proposing at that location.
and I have no objections to his proposal. I understand that a pierluncoverrd beat lift must be mci
back at a minimum of fifteen (15') from my area of riparian access unless waived by me.
1 do eot wish to waive the setback requirement.
11b wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filsd in by individual proposing developmr_nt)
Signature Print or Type Name
T elephone Number_-_-