33180_KEETER, CHARLES_20030213

.FICAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification El Complete Reissue ❑Partial Reissue
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 NO
Applicant Name 1,71 -
Address
City !
State ZIP
Phone # O ' ''
S ' = `
Fax # ( )
Authorized Agent
Ar ,-I, 1 d
Affected ❑ CW
❑ EW
❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no
PNA
yes / no Crit. Hab. yes / no
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County Cf v
Street Address/ State Road/ Lot #(s)
r ) �
Subdivision
CityZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: /✓sue )
Pier (dock) length
Platform(s)._..-
I
Finger pier(s)
AL 1
Groin length
number
i
—
i
Bulkhead/ Riprap length
I
I
I
I
avg distance offshore
max distance offshore
Basin, channel
I ...:........
.-
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_
1
c
C
P'
J
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v:
,
i
cubic yards
Boat ramp
4
Boathouse/ Boatlift
�i
Beach Bulldozing
_
Other
I I
lull
Shoreline Length
NK
i
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I.
SAM not sure yes no
�--
Sandbags: not sure yes no
Moratorium: n/a yes ,no
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Photos: yes no,
Waiver Attached: yes no,
- ----
A building permit may be required by:
® See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules Other:
� 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
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

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USED FOR
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1:00000800 24 9 L 2 2S9ES4971ff

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERfUNCOV ERED BOAT LIFT)
Plow 7z lo-�'
I hereby certify that I own property ,adjacent to ��� y_ '§
(Nacre of Property Owner)
property located at
(Lot, Block, Road, etc.)
t�/'izc3i -
on in
(Water/body) (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 pier/uncovered boat lift must be set
back rat a minimum of fifteen (15') from my area of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
`Qj�t�iJ �fi r I
Signature Print or Type Name
Telephone Number ='�-- �- r
Date

02/11/2003 16:10 2528254891 JAMDP PAGE 02
Feb 11 03 04:32p Sea Gate Assoc. (25?l 728-GG94 p.2
ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT
(FOR A PIERIUNCOVERED BOATLIFT)
I hereby certify that I owls property adjacent to ` _ --'-�1� f3
(Name of Property Ownrr)
property located at
(l,ot, Block, Road, etc.)
on
(Wa erbo r) (Town and/or County)
He has dgscribcd to me, as shown below, the development he is proposing at that lot:"ion.
and I hnve no objections to his proposal. I understand that a pier/uncovered boat lift must be set
back at a minlntum of fifteen (15`) from my area of riparian access unless waived by me.
141 nvt wish to waive the setback requirement.
14c wish to waive that setback requirement.
DESCUPrION AND/OR DRAWING OF PROPOSED DEVELOPMENT-
(To be tilled in by individual proposing dcvelopmcnt)
Ttr eFn t w �
Telephone. Nurnberr
Print or Typc Name T
Bate