41306_RANDALL, PAUL_20050411

C=iCAMA / l DREDGE & FILL
GENERAL PERMIT
New Modification ❑Complete Reissue ❑Partial Reissue
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
mppiicant IVame
Address
City
State ZIP
Phone # ( )
Fax # ( )
Authorized Agent
El CW
❑EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): -I OEA
❑ HHF I 1 IH ❑ UBA ❑1 N/A
PWS:
rl FC:
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
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
ty_
Shoreline Length
SAM not sure yes no = 's
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
Vi '' fil /
Ageh�tcor'Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check#
- Previous permit #
Date previous permit issued
rrojeCT Location: l.ounty
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body
C Rules attached.
ZIP
River Basin
(nat /man /unkn)
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's Signature
Iss niu g Date ' Ekpiration 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 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 (252-946-648 I) 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 / 1-888ARCOAST
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

Eric Ellice;
Marine Construction
DOCKS *SEAWALLS* BOAT LIFTS
DECKS & REPAIRS
Telephone : [phone]
205 Nottingham Lane Morehead City, NC 28557
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ADJACLNT a IVAI,IAN Yttf VE.AtTY OW., CA
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Nnme of Intl ividual a}7plying for Perwit:----- L,, • , RECEIPT
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1 hi levy certify that }awn property :uljdcelZi COer ��) 51,75
applying, for this permit lim describ d to r:io r c3 �,�
they are proposing. A description or &awin � cend�..�rw•a�•al
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!f you have objections to wheat is Mu
hlaira ement, 1ltsttvIn Plaza 11, 151-R, Airy,
2808 within Ili mays of receipt of this notice. N—
(f you ltnve bee1A nulled by Ctrtij7erl Mail,
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ADJACENT RIPARIAN PROPERTY OW.NrER STATEMEN T-2 2005
(FOR A P'Ekl"CO VERED BOAT LIF7)
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I hereby cemify 'that I own property adjacent to ti, I -4-N
(Name of 'Property Owner)
properly located at 1,,t
on e krvv -, L W,,zAe (14t, Block, Rot , etc.)
(Waterbody) 0 A r, , I cl�i C -I t � I'le A N.C.
(TOW10 &adlor COZY)
He has described to M, e, as shown below, the development he is Proposing at that
locabon, and, I have no objections to his proposal. I understand that a pier/uncovered boat Lift
must be W back a minimum distance or fifteen feet (15,) frorn my area of riparian access urJess
waived by me,
I dQ W wish to waive the setback requirement.
119 wash to waive that setback requirement.
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EEB 0 2 2005
ADJACENT RIPARLAN PROPERTY OWNER !�iA"TEMZNT
(FOR A prsjrmxcomm moAr jim 11 . "'=ad City DCM
I hiuleby cuff fy 'tMt I own pnapercr adjamt to PIC4%A 4- k A N 0 t L L s
Nun or Property ®wvswr)
proputy ttcated at
(woay)
crown mwor meaty)
He has d"Clibed to me, as thOw'n below, the dcvCloPt'l mt he it at tat
iocation, and, I have no obj4CdOns to his propOW• 1 understutd ghat a pier/ueove�9 boat lift
must be set back a ridnimum distance of i5fteen fmt (IS') ftm my %= of ripatfan access %r"3"
waived by me.
....
1 wuh to wave. the otbarA mguirMOnt.
wish to waive that setback roquirtmmt.
DFSCRIPnON AND/OR DRAWING OF PROPOSED p�MLOM T-
(To be jUled in by lm&WduW prgpodAg
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Punt or Type Name
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Dam.
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2931
ERIC 13. ELLIS
JASA M. ELLIS PH [phone] 66-30/531
205 NOTTINGHAM DR. 133
MOREHEAD CITY, NC 28557 Date
Pay to the /) /G ' /1� / _ *o1lars
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Order of ✓ —T --
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H RST CITIZENS 113
T - r`I Fi st_C3 Bankd2 1 Comperry ` �-
LK'A_I"v �1 Atlantic .tirsZh. N.C. 28512
www.firstcitizens.co
For lJ ..,�� // �-�'X,. � . f.— ►11 `���--_____� I:0531003001:00131?0-8?80'02931GUARD�AN®SAFE Y BLUE ESBL
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