43626_STONE, JOHN & PHYLIS_20051201 (3)

'CAMA / C. DREDGE & FILL
j
GENERAL PERMIT
Previous permit#
❑New L—IModification GComplete Reissue ❑Partial Reissue
Date previous permit issu/ed
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
j (
"_!�iT> fi
L]•Rules attached.
Applicant Name C r 'f ( 11)0 �'" Project Location:
County___
Address %+ e✓ ! ! { ! G e % Street Address/ State Road/ Lot #(s)
City /AJ c•'r i State ZIP
f 1A, r' l L
Phone # ( ) ; LI-% "' 1r73ax # ( ) Subdivision
Authorized Agent City
ZIP
,�T'CW ❑ EW �---
DES --D ES ❑ PTS Phone # ( )
/(
River Basin I.
Affected OEA J HHF ❑ I[IElH UBA N/A
AEC(s): ElAdj. Wtr. Body-
�-� ` `'� ` � !�,- (dar' /man /unkn)
❑ PWS: ❑FC:
Closest Maj. Wtr.
_
Body;
ORW: yes / no PNA yes /" no Crit. Hab. yes / no
Type of Project/ Activity
(Scale:
Pier (dock) length 1 Platform(s)
Finger pier(s)
-- A p.
Groin length `
number - - r------
Bulkhead/ Riprap length 1
� ( f
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other J j ', y+wS �.l♦r�
Shoreline Length
SAV: not sure yes noSandbags: not not sure yes n '
Moratorium: n/a yes n
Photos: yes n
Waiver Attached:
yes no - - - -- -
A building permit may be required by: I CAIr TIC ell L ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature please read compliance statement on back of permit
Application Fee(s) Check #
Permit,.0'ler's Signature
Issuing Date E pi on 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:
U Tar - Pamlico River Basin Buffer Rules ❑ Other:
El 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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
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

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/NN'AIVER FORINT
el
` �1/ It 'rz
Name of Individual applying for Permit: '---r
71
Address of Property:
(Lot or Street a, Strict or Road, City & Count;)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
if you Dave objections to ;what is being proposed, please w,ite the Div-ision of Coastal
Management, Hestron Plaza II, 151-B, H►ty. 24, Morehead City, AC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless wai%-ed by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
Print Name
Z�Z—'?Z3- 5,-3%�
Telephone Number With Area Code

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to�e7 h+, w, � i -S eS z
(Name of Property Owner)
property located at /b
3 44Z, Z
i-�
(Lot, Block, Ro
ad, ee/t-�c.)
on o u S e Uc� , inh12L , 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.
I do not wish to waive the setback requirement.
I d4 wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individtcal proposing development)
Iwu'q 1 7 2005
Morehead City DCf'jj
Signature
ne w, r r 4D. AoqGe=
Print or Type Name
,1 ---2-�93--F73-7
Telephone Number
Date: // — /0 — O'

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oray type and Iinnvork Fiat Citize Bank logo on back If not present, ito not cash.
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Matl City, N.C. 28557
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