40741_WHITE, LEON_20041222

C.41VIA / i._ J DREDGE & FILL .9)""G1
GENERAL PERMIT P iouspermit#
FINew El Modification F'Complete Reissue LlPartial 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 Project Location: County___________
Address U'"'' f ' ` Street Address/ State Road/ Lot # s
City A 1 r - State --- ZIP -------- - -- ----- - ----- ----
Phone # O Fax # (`) Subdivision -
Authorized Agent City ZIP
❑ CW OEW D PTA ES PTS Phone # () —__—_ River Basin
Affected OEA ❑ HHF ElIH Fl USA - N/A
AEC(s): Adj. Wtr. Body (nat /man,Junkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body ---
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)___
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore _—
max distance offshore
Basin, channel
1*
�4-
cubic yards
Boat ram
-
Boathouse/ Boatlift—
li y. _
Beach Bulldozing ---------
S
- -� - — --^
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
`_rplicant Printed Nana} '
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Ofli sSignature
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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
j 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 (910-395-3900) 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
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

// P057AL SERVICE® -r v ►71IA-L Al "INN Y M-11)E i
.. . _ o00
SERIAL NUMBER ... .. r YEAR, MONTH; DAY POST OFFICE U `tl6 LLARS AND CENTS.
0705901669l 2004-12-21 85;�0n
�
AMOUNT: LINE HUNDRED DOLLARS 9: Ocil�
PAY TO /� NEGOTIABLE ONLY IN THE U.S.'AND POSSESSIONS.
EN ' SEE REVERSE WARNING
ADDRESS
FROM CLERK
C.O.D. NO. OR� r 1 !
USED FOR 0�1
1:000001300 21: 073590 46691111
Ir«�

ADJACENT PJPAJUA►N
PROPERBYo 3.�.. � -"UMNT
4G PILIf5 d
fF()RA P16)V'"00 f- �!
G
i hereby certify ttmt t own PrOPefty adjacent to _�
(Nion+e of properly ()wntr)
Eli
propemy located at ock, Road, etc.)-- -
on64�� , to (T n and/ar uo nty)
(�,'a ecbodlrl
He has described to ^°e. as shn b,,-low, the de%etopment he is prupU51ng at that 110cation,
tand
and, I have no pbjeCtiorls to
b a msnpmjn. distdne f f►sfteer, fetta(l5) r` m my area
ptisnts,'kxo.tl,Wboathoust must. be set
of riparian a:cess unless waived by me.
6 dig no, wish to wave the SCqhhcK rcQuire,r,ent.
1 do wish to wave that setbAck regkJivnent.
..............
T'E;,SCi(tP'i'dU, AND!OR�DRA`YING OF PROPOSED DEVE WP IENT:
(To be f hell in by individual Proposing developrntrt()
' Pro
��c.�<
1----
ff,Kts
Sign�tut� "
print or Type Name
Te)ephone Numbv
Date 4�
�� U
Sk

AW N ' RIPAWAN pRopERI, y OWNER � �� �` I'
,(FUR AADJ1i'IERi�6f+DOR11yG PI1.11�GSE8 3�(e ••��- K � l
v
v 'S
i hereby certify that I own pmperty adjacent to
(Nzante of Peon y (2wneri
t�
Vroperty located at ock, Road, ete.i
in
on (? n and/or County)
(�Va4erbody)
He has described to nee as shrµr, belo,v, the de%,etapmartt he ss proposing at that locA.00P,
and. I have no objections to his proposal. C uncierstand that a pier,'mc►c'ring
piling&Jb0atVL/boath'0uye rust be set back a min:msn, distance of `cfteer. feet (15') fram my a7sa
Oil riparian a.:tess k)r31ess waived by me.
( wish to waive the setback requirement.
0 to wash to wive that setback req�.ire+nent.
..___-.
Df:SC Fttr'j-10N AND OR. r)R.,4%VTNiG OF P opo EDVELOPMEVT*
(To be filled in by ludavWual proposingdevelopment)
e5
c
print or Type Name
7 5 _ _ ---- - ---
i-elephone Number
Date: 12Z
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