41755_POTTER, MARY_20050614

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CAMA / 19-DREDGE & FILL ��/ 0 'f 55
GENEFKAL PERMIT
Previous permit # r✓�/�
P,New' ❑Modification ' (Complete Reissue ❑Partial Reissue Date previous permit sued /y!1
As authorized by the State of North Carolina, Department of Environment and Natural Resources 1/ O J
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Q i
y Rules attached. 1
Applicant Name 4� y ✓ Project Location: County_ _ ¢ ° ` " �
Address - _ f �.. t ✓"' d � L J Street Address/ State Road/ Lot #(s) L• -r- / '3
City y e . � a' . State ZIP ` S / i� + -4; +1 . iV
Phone # C j: ) � j � � Fax # ( ) / Subdivision
Authorized Agent
l ie r/1.�f' l?[ `� !V ' Jy?
�/ _"�, � y � r't City � _ ZIP r
Affected ET CW PE-W F,.HP A @'EIS ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A1
AEC(s): Adj. Wtr. Body �at man /Jinkn)
—
ORW: yes / no PNA yes / no> Crit. HabClosest Maj. Wtr. Body
. yes / no -
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
3 O AJ b
Bulkhead/ kiprap length
avg distance offshore L
max distance offshore
Basin, channel
-
cubic yards
Boat ramp
Boathouse/ Boatlift
i
Beach Bulldozing
W
Vfi
Other
i
r r _
Shoreline Length 0
SAV: not sure yes no
Sandbags: not sure yes ( no
Moratorium: n/a yes
Photos: yes ty
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
r�r
Signature "Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
y-7
C�e note on back regarding River Basin rules.
Permit Officer's Signature
A_)y � 'q- lv o_(
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

w
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, 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
L Neuse River Basin Buffer Rules
�_ � 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-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

`` , CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DI`-ISION OF COASTAL NI_kNAGENIENT
ADJACENT RIPARIAN PROPERTY OW.N-ER NOTIFICATIONA NAIVER.
FORM
Name of individual applying for permit:
Address of property: ! Eit ��•: rc. �,t`-�'`��'�j or.! ---
i (lot or street #, street or road) ( -
V4 � J iL ( � �'"9 J
(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, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
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, breakwater, boathouse, lift or sandbags
must be set back a minimum distance of 15' from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
_ I do wish towaive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
Print Name
5-1 G33 -wl09
Telephone Number With Area Code

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MARY N. POTTER 4H4%
NCDL 333988 PH 728-4723
200 SHERWOOD BLVD
BEAUFORT, NC 28516 66-7704/2531
DATE
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PAY TO THE I s
OR ER OF
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DOLLARS W e.°TV"°°
State Employees' Credi i
6 Morehead City, North C,arioli.
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