40904_PURVIS, CARL_20050204

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L:�CAMA -DREDGE &FILL
GENERAL PERMIT 'o� Previous permit #
11, New ❑Modification 1 ]Complete Reissue F 1Partial 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 15A NCAC
Rules attached.
Applicant Name f f -!''� `' +-S Project Location: County --
Address �� ' c 1" I'� Street Address/ State Road/ Lot #(s) - --
City ; 'v c k,l (; tf+ /I l State-, ZIP % 4�
Phone # ( ) 7'. Fax # ( ) Subdivision
Authorized Agent !� P f ��%'CIL., % S City, ; v, r (:'' j t r - - — ZIP �• ' %
Affected -
ii CW < PTA DES ElPTS Phone # ( ) River Basin
—
F1 OEA ❑ HHF ❑ IH ❑ USA ❑ N/A (-
AEC(s): Adj. Wtr. Body ?, , e• t/ " —i - - •' ---(nt !man unkn
L' PWS: ❑FC:
ORW: yes / no PNA yes / no % 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
Boathouseoatli j _
Beach Bulldozing .i
Other
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(Scale: ,,IJ.J—_ j )
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p 7c.jts'
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Shoreline Length ` t
SAV: not sure yes no
Sandbags: not sure yes no ( l
Moratorium: n/a yes of
Photos: yes 'no
Waiver Attached: yes ,,no
A building permit may be required by: Fir ]'
Notes/ Special Conditions !�
Agent or Applicant Printed Name
/ n
See note on back regarding River Basin rules.
Signature Please read compliance statement on back of permit Issuing ate xpirat9"on Date
r . C j
ApplicationFee(s) Check# 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
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 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
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.nccoastaimanagement.net
Revised 10/05/01

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DR. CARL G. PURVIS
MEDICAL AND SURGICAL FOOT & ANKLE SPECIALIST
DIPLOMATE OF THE AMERICAN BOARD OF PODIATRIC SURGERY
FELLOW OF THE AMERICAN COLLEGE OF FOOT AND ANKLE SURGEONS
DATE: ' / 1 % I G f'
PHONE: [phone]
FAX: [phone]
TIME:
As woo*'l
TO: PHONE #:
COMPANY: s� Q +C Ulf t MA(-!AJ CON -rF(fA4 C T-)O I.)
FAX #: 'l10 r8 5'-)3 PAGES: 3 (Includes cover sheet)
FROM: �A'r'�( I.
RE:
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MAIL.
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IF YOU HAVE NOT RECEIVED ALL OF THE ABOVE PAGES, PLEASE CALL US.
THE INFORMATION/COMMUNICATION CONTAINED IN THIS FACSIMILE TRANSMISSION IS PRIVILEGED AND
CONFIDENTIAL INFORMATION AND 1S INTENDED FOR THE USE OF THE ADDRESSEE ONLY. 1F YOU ARE NOT THE
INTENDED RECIPIENT OR AN AGENT RESPONSIBLE FOR DELIVERY OF THIS MESSAGE TO THE INTENDED
RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISCLOSURE, COPYING, OR DISTRIBUTION OF THIS
MATERIAL IS STRICTLY PROHICBITED. IF YOU I IAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE
NOTIFY US IMMEDIATELY 13Y TFLEPIIONE" TO MAKE ARRANGEMENTS FOR RETURN OF THE ORIGINAL
DOCUMENTS TO US.
3301 SUNSET AVENUE SUITE C - ROCKY MOUNT, NC 27804-3513 - (252) 443-71 14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIF (BOATHOUSE)
I hereby certify that I own property adjacent to
CArR L PU2✓).S 's
(Name of Property Owner)
property located at —70 ( T 5'Qt { © �R '
(Lot, Block, Road, etc.)
on
�a� Sow /J.�% , 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 back a hisP i�pmr m distance of fift edn feet(15') fprom my area
pilings/boatlift/boathouse must be set
of riparian access unless waived by me.
I do nQt wish to waive the setback requirement.
Q`.
I do wish to waive that setback requirement.
-
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DESCRIPTION AND/OR DRANVING OF PROPOSED DEVELOPMENT:
(To be filled in by Indii-idual proposing de► clopneent)
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Telephone Nwnber
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ADJACENT RIPARIAN PROPERBoOWNE ATMENT
(FOR A PIER/MOORING PEOA E
I hereby certify that I own property adjacent to
CAL PWRV1 S 'S
(Name of Property Owner)
p� # S�No QietJ� ,
property located at
(Lot, Block, Road, etc.)
on
�b6-tkE- SOU^ice ' inFiitil , 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
t back a minimum distance of fifteen feet (15') from my area
pilings/boatliftlboathouse most be se
of riparian access unless waived by me. Y
I (lo no wish to waive the setback, 'requirement.
1 do wish to tivaive that setback requirement.
- - -------- -
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DESCRIPTION AND/OR DRANVING OF PROPOSED DEVELOPMENT:
3 (To be filled in by individual proposing development) �;.
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