40051_PEELE, ED_20041006

• LICAMA / '_i DREDGE & FILL
GENERAL PERMIT
# a .
Previous permit
INew �-1Modification'.Complete Reissue ❑Partial Reissue
Date previous permit issued i e�
As authorized by the State of North Carolina, Department of Environment and Natural Resources
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and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
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CQRfiles attached.
Applicant Name - "� E��
Project Location:
County______
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Address -" -
Street Address/ State Road/ Lot #(s)
City a u State ZIP
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Phone # ( ) Fax # (`)
Subdivision
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Authorized Agent G r?�
City
ZIP
CW ELEW n PTA ❑ ES ❑ PTS
Affected
Phone # ( )
River Basin
ElOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body
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!v �� _ (nat- man /unkn
❑ PWS: ❑ FC:
m
ORW: yes /: no PNA yes / � Crit. Hab, yes / no
Closest Maj. Wtr. Body- -
Type of Project/ Activity
Pier (dock) length
Platform(s)_ _
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
1
1
�L1(ir Ou G! LV o c: v c
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Shoreline Length = 1
SAM not sure yes no -----
Sandbags: not sure yes ono
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no - -
A building permit may be required by: r�<`
Notes/ Special Conditions 1 %
(Scale:
See note on back regarding River Basin rules.
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Agent or Applicant Printed Name Permit Officer's Signature
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Signature Please read compliance statement on back of permit
Application Feels) Check #
Issuing Date Expiration Date
Local Planning Jurisdiction 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 consistentwith 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: [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 i 0/05/0 i

PRESCOTT BROTHERS INC
141 TARA TRL
GRANTSBORO, NC 28529
PAY
TO THE
ORDER OF
0 F)Rsr CITIZENS 472
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Firat-Citizans Bank B Trust Company
�� Oriental, N.C. 28511
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2720
_ / 66 30/531
DATE C.O" 472
1102S429ol
DOLLARS 8""eK�
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ADJACENT RIPARIAN PROPERTY.' O'4'4 NTR STATEMENT - -
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I hereby certify k�e � that I own property adjacent to �d �('s
(Name of Property O wrier)
proper-ty located at 014- (,I'll
(Lot, Block, Road, etc.)
��CD N.C.
on ��Z L� , in U�% � i
ff2terbody) (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.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT
I(To be filled in by individual proposing developmenl)
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Telepho.,e Number
Date: 1L4L r4'
I
—29—

ADJACENT RIPARIAN PROPERTY OWNTR STATEMENT
,
I hereby certify that I own property adjacent to �!/" ��/'/ E-561s
(Name of Property Owner)
property located at &w� f0
(Lot, Block, Road, etc.
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on in , I�'.C.
(Waterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEULOMMENT
(To be filled in by indii,idual proposing development)
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Print or T)'pe Name
_'� ��C,�
Telephor{e Number
Date:
-29-