42497_PHILLIPS, PALO_20050810

LAMA / DREDGE &FILL! d ny/'4? _ 97
GENERAL PERMIT Previous permit #
[-iNew !-.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 I SA NCAC
y i `. [] Rules attached.
Applicant Name ! ' + (' Project Location: County
Address " (, l�" y Street Address/ State Road/ Lot #(s)
City
Phone # ( )
Authorized Agent
Affected `-' Cw
AEC(s): `J oEA
[l PWS
ORW: yes / no
i
_ State
Fax # ( )
l[ EW Fl PTA
El HHF f" IH
G' FC:
PNA yes 1 no
Type of Project/ Activity
Pier (dock) length f
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
Shoreline Length
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
Agent or Applicant Printed Name
ZIP..
Subdivision __
City ZIP
ES ❑ PTS Phone # ( ) _ —River Basin ' -'�i' � J'' !` j /`
UBA ❑ N/A Adj. Wtr. Body _ _ (nat /man /unkn)
Crit. Hab. yes / no Closest Maj. Wtr. Body
Signature ** Please read compliance statement on back of permit **
(Scale:
See note on back regarding River Basin rules.
0
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # Local Planning jurisdiction
Rover File Name

1.
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:
F _1 Tar- Pamlico River Basin Buffer Rules
1 ] Neuse River Basin Buffer Rules
L _1 Other:
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 / 1-888-4RCOAST
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

(� MATTHEW W. HORTON "-"551 A'XLI 7435
SUELLEN G. HORTON 531
LIC. 4308110 NC 1079156 552430421
7345 BARHAM HOLLOW DR. PH. 919-554-4085
WAKE FOREST, NC 27587 642
r u f - - � -
CCBCentral Carolina Bank 551
IiolewMe, North Carolina 27571
7
1:053 100465li: 55 24304 2 LII' 74 5

UNITED STATES POSTAL SERVICE
First-Clas' Mail
111111 Postage 8, Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
i�b,� W In ekes ids
te-
"7s a,
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
�i �c6c Salo t '4vo
A. Si nature
X ` ❑ Agent
❑ Addres
B. Received by (Printed Name) C. Date of Deliv
D. Is delivery address different from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. 85pfilce Type
rtifled Mail ❑ Express Mail
Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 2890 0003 4770 5037
(DansfHr from service labs!)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-t540

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
pun
(FOR A PIERIMOORING PILINGSIBOAT7-IFTIBOATHOU.SE)
I hereby certify that I own property adjacent to TAJC pViet ( I 'PS s
(Name of Property Owner)
property located at
L. iQ& V ay., �A �
(Lot, Block, Road, etc.)
ks ,
on �JGYi� U� `�U.v1 s , in New 4r� 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
pilinas/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of n'parian access unless waived by me.
I do not wish to waive the, setback r uirement.
I .L wish to waive that setback requirement:
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP,-'v NT:
(To be filled in by individual proposing det,eloprnent)
S o O
56t
----------------- ---- ------ ----------------------------
S---�
Signature
N
Print or Type Name
asp - a a3 - �P' -7C)0
Telephone Number

UNITED STATES POSTAL SERVICE
First-Cla4 Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
Ubvi W k i+e-6 tJ-r—
C/o t � T le, "Rela.l
'7svIQ-e—
�,
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
jb5'ny�It V'te'e52-VjeC
L�."fax 1 T
el
A. S7ure I
t —; gent
0 Addressee
B. Received by ( Printed Name) C. Date of Delivery
iAkk1- 8,5u-0-e- 1-7 7S-0s
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑,No
3. ffrvico Type
Mail 17 Express Mall
egistered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Edra Fee) ❑ Yes
2. Article Number labs! 7004 2890 0003 4770 2609
(Tn3nsfe,r hom service
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-WIS40
13
s

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIB04TLIFT/BOATHOUSE)
I hereby certify that I own property adjacent toca--��t��t�� s
(Name of Property Owner)
property located at
(Lot, Block., Road, etc.)
an St���c ►�td _, in lV.%p�r t' , N_ C.
(Wa 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 pier/mooring
pilin¢s/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of rip access unless waived by me.
I do not wish to waive the setback requirement.
I .dL wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP,vM-NT:
(To be filled in by fndividual proposing development)
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Print or Type Name
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State of Norte:? Carolina 44MT Co.
I , 6kAt-s .4, AAI .61jCll..certify that
this Imap was drawn under my super-
vision from an actual survey made
under my supervision; that the
ratio of precision as calculated
by latitudes and departures is
1//a,000f that this map was pre-
pared nz accordance with G.S. 47-
30 as amended. WITNESS my hand
and seal this2; -fiay of ,dMY—I—,
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