40358_PETERSON, RUSSELL_20041129

D CAMA / C! DREDGE & FILL
GENERAL PERMIT evio r`-
PFevious permit #
DNew LIModification -'Complete Reissue ❑Partial Reissue Date previous permit issued j
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
❑ Rules attached.
f Applicant Name Jr` �/ e'cc 1D r.. Project Location: County J i
Address 1 % (% '� �r r Street Address/ State Road/ Lot #(s)
1c r /�<1 7r
City /," 1 c State_; ZIP
Phone # (�) 2- Fax # (�_) Subdivision
Authorized Agent City / ` ` _ _ ZIP
Affected Cw J EW ❑ PTA I ES C'. PTS Phone # ( ) River Basin
❑ OEA L HHF [7 IH UBA ❑ N/A
AEC(s): Adj. Wtr. Body (nat1man unkn
ge
ORW: yes / no PNA yes / nn Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length S 3.1
Platform(s) % 3 �
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 0
ovr . of./%
Shoreline Length 00
SAM not sure', yes no
Sandbags: not sure yes no.
Moratorium: n/a yes no,
Photos: yes no
Waiver Attached: yes no,
A building permit may be required by:
Notes/ Special Conditions
l 4' . J,
Agent 6r Applicant Printed Name / `-'
1)oN (lX e&drl�
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
�'6
(Scale:
See note on back regarding River Basin rules.
y is
Permit Officer's Signature
Issuing Date
Expiration Date
/0
Local Plan ningjurisdiction
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 L j 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
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

im
ODONALD R. OXENDINE NCDL 3584956
DONNA O. MOLINA NCDL 8050154 OSO
Phone [phone]&7704/2531
5114 Kershaw Road
Oriental, NC 28571 �
' Date
Pay to t f e A 40 .
order o w1
�i
State Employees' Credit Union
34 New Bern, North Carolina
For `apC
1:2531770491:086309L.8679u• 1050
nr

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1'
ADJACENT RlP PROPERTY OVQNER STA. '
(FOR A PIERIMOORING PILINGSIROATLIFTIROATHOUSE)
I hereby certify that I own property adjacent to ti C- C `� �5�-� s
(name of Property Owner)
pmpertY located at L o � \ \ 1 / ( ) \ '
(Lot, Stock, Road, etc.) I -
on n v15
in N.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. I understand that a pier/mooring
pi)ingslboatlift[boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
i dR wish to waive the setback requirement.
I d_Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be,filled in by individual PrOPOS'ng development)
i
Signature
Print or Type Name
X ZS o� o� 1�457
Telephone Number
Date:�2-

14 J-�a 5 (0 1)
ADJACENT RIPARIAN PROPERTY OWNER ST.ATEMET7
(FOR A PIERWOORIIVC PrUNGS/B4A7VFVB0A7
N0
USE)
� �.. '
I hereby certify that i own property adjacent to A S- D � s(Name of Property Owner)
property located at !~ 1
(L,ot,'' lSlocjc, Rood, etc-)
in_ram tn�`' 114 r C , N.C.
�'n.�i-'��`Z" (Town and/or County)
(Waterbody)
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/mooring
pilinpromdiftfboathousc must be lei back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me-.
I dog wish to waive the setback requirement.
1 dl wish to waive that setback requirement.
DESCR11MON AND/OR DRAWING OF PROPOSED DEVELOPMENT'
(To be ftUed in by individual proposing derdopment)
n . or Name _
ws ZYlb-02-5r 04�
x;f eh Number
Xnate: