42963_SMITH, PAUL_20050928

iJCAMA / r DREDGE & FILL
GENERAL PERMIT
C']New ]Modification ❑Complete Reissue CJPartial 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
P. l 1,- L I ,
Previous permit #
Date previous permit issued
�F/ / #'C
N�Rules attached.
Applicant Name Project Location: County ^r 1 t /
Address S c� f �ri 1 �"� l�✓ Street Address/ State Road/ Lot #(s)
City 6, e 4 - 1 State /tJ<- ZIP � �r�` i c. ��/r�, ,''r A
Phone # O " i I- I i i Fax # O Subdivision -�
Authorized Agent =� "�' i' ="' City �_ "A?P �f! ✓ �r i -' ZIP a� U
Affected L' CW �-,MW ElPTA �ES ❑ PTS Phone # ( River Basi Il- j d
❑ ❑ ❑ OEA HHF IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body �� )at Iman unkn
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Win Bo
Type of Project/ Activity '
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number I
Bulkhead/ Riprap length_
avg distance offshore=
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
Shoreline Length
SAV: not sure yes
01
Sandbags: not sure yes /f o .
Moratorium: n/a yes : o f
Photos: yes o:
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 bac of permit
Application Fee(s) Check #
(Scale:
1
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration 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:
_i 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 (910-796-7215) for more information on how to comply with these buffer 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
Fax: [phone]
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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hereby certify that I own property adjacent to
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in �id ��E T N.C.
(water Body) (Town and/or County) z.?SBy
40 has described to me as indicated below the development
he !illy proposing at that location and I have no objections
to s proposal. I understand that a pier, pilings and
dre drag must be set back a minumum distance of fifteen feet
(15� from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development;
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dr ing must be set back a minumum distance of fifteen feet.
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I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
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dreg ing must be set back a minumum distance of fifteen feet
(159 from my area of riparian -access unless waived by me.
I� I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Cescrigtion and/or drawing of pro osed development:
(To be f-illed in by individual proposing development.)
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