40938_SUGG, JOHN_20050314

I_ ICAMA / J DREDGE & FILL��nJ�7 CL
GENERAL PERMIT Previous permit#
❑Ne4N IModification C,Complete Reissue GPartial 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 % f i f Project Location: County
Address �t J `~rJ �� / t J '� `' e. Street Address/ State Road/ Lot #(s)
City State 1' ZIP
Phone # JI0 ) �3� 6 � Fax # ( ) Subdivision
Authorized Agent 'a+'� /� ��'' ��'"��' City --_ _ / ZIP
k
Affected 1 Cw ❑ PTA EIS ❑ PTS Phone # ( ) _ River Basin
ElOEA ❑ HHF ❑ IH ❑ USA ❑ N/A
AEC(s): Adj. Wtr. Body gnat /man /unkn)
C] PwS: ❑ FC:
ORW: yes / no. PNA yes /, no, Crit. Hab. yes / no Closest Maj. Wtr. Body
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
Shoreline Length -
SAM 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
(Stale:
See note on back regarding River Basin rules.
Permit Officer's Signature .—
y-
Signature Please read compliance statement on back of permit
Application Fee(s) Check#
Issuing Date Expiration Date
v ( /' 1 J /ice''
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:
E]Tar - Pamlico River Basin Buffer Rules n Other:
-i'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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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
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 STATIMENT
(FOR A PIERIMOORING PILINGSIBOA7UFTIBOATHOUSE)
I hereby certify that I own property adjacent to '-:7� �� � is
(Name of Property Own )
ply Iocateci at o r kA,-\ SSo r e- S r- .
(Lot, Block, Road, etc.)
in �O� FYI �'> > 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/boatliftlboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I o nut wish to waive the setback requirement.
I sit wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
A,k2,4 Z d cZ4 I lee .0
Print or Type Name
Telephone Number
Date: - 7 V 'el

02/22/2005 11:32 FAX [phone]
=eb 22 05 11:31a Don Oxendina
HQ_AETC/DOZ
252-248-3714 1Z.1
Z02
ADJACEr" RIPARIAN PROPERTY OWNER STA119AIENT
(FDR A MMMOORING PJZJNGSIBOA 7UFTIBOA THOUSE)
I hereby certify that I own property adjacent to , r) ti-Z � N � ti c Ga -- 's
(Maine of Property 0* )
ply locamd at c_� Y c�� C r
(Lot, Bloch, Road, etc.)
on ` J, �� 5 f' - "Pr.C-Y-1 ' sc C� , N.C.
(Waferbody) (Town and/or County)
He has des= -bed to me, as shown below, the deveioopsim t he is prupasing at that location,
and, I have ne obiCCUO is do his proposal. I understand that a pier/mooring
pilingslboatizftlboaftuse must be set back a minimuin distance of fiftmn feet (15') from my area
of ripaxian access unless waived by me.
I s3,u not wish to waive the setback requirement_
I dg wish to waive that setback requirement_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Ta be f Ued in by individual p+ropasing deveLopmsnt)
Si
1., guts � �o ►J E-�
Print or Type Name
Flo- qO'3-
Telephum Number
Date:
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