41908_SPEED, WILLIAM_20050629

C_iCAMA DREDGE &FILL
GENERAL PERMIT ,�
Previoir� permit #
CINew ilModification JComplete Reissue ❑Partial 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 J j�""?�-r� Project Location: County_
Address � � '� Street Address/ State Road/ Lot #(s) i
City ¢ ., id r' State ZIPS
Phone # (_21 ') "? ')-?- 7 � o l Fax # ( ) Subdivision f
Authorized Agent City_ N - ZIP
L.I CW I-EW &PTA 'ES ElPTS Phone # ( ) River Basin
Affected El OEA ❑ HHF ElIH G UBA ❑ N/A j /` ,� , �
AEC(s): Adj. Wtr. Body ''! (na /�Junkn)
❑ PWS: ❑FC: r
ORW: yes / no, PNA yes / (no) Crit. Hab. yes / no Closest Maj. Wtr. Body / '�� ' -' r%r G• ` �' J
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s) _
Finger pier(s)
Groin length
number _
Bulkhead/''Riprap length % `�
avg distance offshore e!
max distance offshore f
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length _
SAV: not sure yes_ -
Sandbags: not sure yes no
Moratorium: n/a yes n
Photos: yes
Waiver Attached: yes n
A building permit may be required by:
Notes/ Special Conditions
a
Agent or Applicant Printed Name
Signature Please read compliance statement o'n back of permit
Application Fee(s) Check #
EI See note on back regarding River Basin rules.
PeOf t Officer 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:
� _J Tar - Pamlico River Basin Buffer Rules ]Other:
0 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 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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERAVOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(ti'ame of operty Owner)
property located at
(Lot, Block, Road, etc.)
on I%� R'! S F�L- % , in /,�� �/ ��/ , N.C.
(Waterbody) (Town an 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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
{� I do not wish to waive the setback requirement.
I d_Q wish to waive that setback requirement.
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DESCRIPTION Ati-D/OR DRA«'I\G OF PROPOSED DEVELOPMENT:
Iledd in bb iinndi�,idua)l proposing development
� � i� ev _//
lff7�
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Signature
o � . 3.
Print or Type Name
Telephone Number
Date: �'flCol os

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
411�9
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE) �105
I hereby certify that I own property adjacent to _ Ju RM
(Name of Property Owner)
property located
, Block, Road, etc.)
on 4 -1 S" C --r�" L 11r, in / (1 L_ f'r� 4 z /' r'4Z , 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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
j% I Flo not wish to waive the setback requirement.
I d wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWf G OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number f
Date: � _ � ✓��

MATHEW S. PETERIK DL 8696205 66-7704-2531 2726
TONYA PETERIK
105 OWLS NEST CT. NEW BERN, NC 28562 200{'
N pAY T HE ORDER OF
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DOLLARS
STATE EMPLOYEES' .CREDIT UNION
BR. 65-WASHINGTON, NORTH ARO�UL`IIIN(/A��
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