40926_RUBENSTEIN, DAN_20050208

�E-CAMA / l ' DREDGE & FILL
GENERAL PERMIT
❑New ElModification ❑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
N �A 40,926
--11 vious permit #
Date previous permit issued
les attached.
Applicant Name f. s Project Location: County
Address J `� X l `� �t
Street Address/ State Road/ Lot #(s)
City (' / '` - IT, 1,J C
State V c ZIP �f "7
Phone # (J ")
,C (] If
'" I 1 Fax # O
Subdivision
Authorized Agent
�o ,'/
�) c �p eJ t
City G' ;' it :' ! ZIP ' - 7t
CW
CHEW
H-PTA ❑ ES ❑ PTS
Phone # ( ) River Basin f
Affected ❑ OEA
AEC(s):
❑ HHF
❑ IH -; USA ❑ N/A
, Qs.
Adj. Wtr. Body A' t,� 1 ° ' f (nat /man /unkn)
ORW: yes / no;
PNA
yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)-
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore _
max distance offshore
Basin, channel
cubic yards __
Boat ramp
Boathous oatlif J `
1
Beach Bulldozing____
Other
Shoreline Length
SAV: 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
Signature ** Please read compliance statement on back of permit **
(Stale" / A) r k-
See note on back regarding River Basin rules.
Permit Officer's Signature
cs
.J
Issuing Date Expiration Date
Application Fee(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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
I Tar - Pamlico River Basin Buffer Rules Other:
—}'f use 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:
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

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66-7704/2531
done /2�2JJ 2�-0242
O,Yiuz ,, ✓W —9(?671 Date
Pay to the
Order of `✓
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State Employees' Credit Union
34 New Bern, North Carolina
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For
1: 2 S 3 177049,1:086 2576 2 1
2L, 1078

Feb 08 05 03:23p Rai McNaughton 804 784-5014 p.l
rP.0 UJ 05 06:26P Don Oxendine 252-249-3714 P.1
A►DJAC`ENT RIPARIAN PROPERTY OWNER STATEMENT
(POR A PIMMOOPJNG PIL,/NQVB0A7IJFT/80AIWOUS0
I hereby certify that I own property adjacent to I ck (-A `?- `L) Dana b n A'o-, r'
(Name of Property Owner)
ply located at 9 Z l c,4-14�
(Lot,, Block, Road, etc.)
oT►�`J �.)y"7 (>yl{��f-e qJ , in - �J— 1 r� ,r') �rx_ \ , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that Iocazion,
and. I have no objections to his proposal_ I understand that a pier/mooring
piIingsiUadifi/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do -a t wish to waive the setback requirement.
1� i do wish to waive that setback requirerr&m.
DESCRI MON AND/OR DRAWING OF PROPOSED DEVELOPMENT;
(To beJWed in by individual proposing development)
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Signature
Print or Type Nam&J
YoL( ?-�- L(-
Telephone Number
TDate_ z / 7 / 0 S

FEB-03-2005 08:54 PANTEL CONTRACTING CORP 0452988593 P.01/01
ADJACENT R&ARLAN PROPMTY OWN M STATIIv tr
(FOR A plMM00RAVG Plll)VGS/B0A7ZIMBOATHOUSEE
X hereb certify that own property adjacent to, n`�- OnsZ
y lx�
(Name of Property Owner)
plvyaty located at " I J
a4t, Block, Road, etc.)
pn� . > �'7 n rl (� , in N.C.
(Waterbody) (Town and/or Gnarly)
He has described to me, as shown below, the develapmast he is proposing at that location,
and, I have no objections ID his proposal. I anderSWW that a pierimooring
pilings/boadift/baathouse must be su bade a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I d2110t wish to waive the setback requirement.
I & wish to waive that setback requirement.
DFSCRIMON AND/OR DRAWING OF PROPOSED DEVEW ENT:
(To be JU[cd in by individual proposing development)
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print or "type Namc
(0,4-sl z 9f-s z s ,
Telephone Ntxmber
Dare: 2 % %s
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TOTAL P.01