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J'CAMA / 7 DREDGE & FILL
GENERAL PERMIT
JNew E lModification 1Complete 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 I SA NCAC
Previous permit #
Date previous permit issued
7 0 1,(
❑ Rules attached.
Applicant Name r I' ii•h/' % l r
Project Location: County a v'rc.
Address 2 i { (" V ► J.f Street Address/ State Road/ Lot #(s)
City fk(t 4 State ,� ZIP 60,5 rG+ r,--
Phone # (—) 71 L- 4,c 1 Fax # ( ) Subdivision
Authorized Agent — --- City , 1 E r ZIP
Affected CW 'i EW ❑ PTA h7 ES [2PTS Phone # River Basin P w rt
•
AEC(s): OEA C' HHF ❑ IH ❑ UBA ElN/A Adj. Wtr. Body h « 1 t ` " �1t,at /man /unkn)
❑ PWS: AFC: n
ORW: yes / 0 PNA yes / pp Crit. Hab. yes / no
Closest Maj. Wtr. Body Alf a f-
Type of Project/ Activity c /►�<� i /
(Scale: n1 r n/ E )
Pier
Platfo
Finge ONE ON
Groin length
rnber
Bulkhzad/ Riprap length
vg distance offshore
Basin,channel
Fubic yards
Boat ramp
Boat
Beach
Othe
Shoreline
SAv: not sure yes no
Sa4ags: not sure yes no
Morall-orium: n/a yes no
Phot is: yes no
Waiv :
A building permit maybe required by:
Notes/ Special Conditions l� %
I ' � �
MEN
N
NO
MURK
CFO
INN
MEEMON
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on back regarding River Basin rules.
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See note
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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
�'r'vr►. ic . )zM 69A
Local PlanningJurisdiction Rover File Name
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
�'r'vr►. ic . )zM 69A
Local PlanningJurisdiction 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
landowners).
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 ❑ 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 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:919-733-I495
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-13 Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: 910-350-2004
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastaimanagement.net
Revised 10/05/01
CHUCK LEWIS
2201 FRONT ST PH 252-728-4001
BEAUFORT, NC 28516
PAY
" TO THE
ORDER OF.
L
C '
FOR
vTACHOVIA
Wachovia Bank, N.A.
Iknuforl. NC 2K)16
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(�PC3394(1-
1180000L45511' 1:05310L5291:
1455
66-152/531
DATE
DOLLARS
Details on back
5466 L 26 L 5 3u'
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1' 1
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
�nl��.��.
Name of Individual applying for Permit: 5� + S
Address of Property:
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plan II, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakxater, boat house, lift or sandbags must be
set back a minimum distance of I5' from my area of ripar,an access unless waived by me. (1- you
wish to waive the setback, you must initial the appropriate blank below.)
t/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature _ Date
Print Name
2 > b�
Telephone Number With Area Code
waaI ".
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit:— CAAV / P
// XX
s of Property:
0A
(Lot or Strae, 4% or Road, City & County)
I hereby ccr-ary that I own property adjacent to the a:,ove reverenced PrOPe,tY.Th,. individual
applying for this permit has described to me as shown on the attached drawing
the development
t1epv a_e proposing. A description or drawing, with d:.:,ens:ons, should be provided with this
l..�e..
y I have no objections to this proposai.
If You have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plan 11, 151-B, Hwy. 4, MorehEad
C:rv, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response :s considered the same as no objection
if you have been noti.i ed by Cerli ed Mail.
WAIVER HMO',;
I c:,cerstand that a pier, dock, mooring pilings, breah7xate-. boa: house; lift or sandbags must be
back a minimum distance of 15' i;om my '
area of rp,ana- access unless waived by me. (I: you
w _:7 to waive the setback, you must initial the appr op,;at below.)
I do wish to waive the 15' setback require.-.eni•
I do not wish to waive the 1 5' setback re^ :irement.
Signature _ Date
Pant Name...
t e:ephone Numbe; With Area Code
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