41110_WHITTAKER CK YACHT OWNERS ASSOC. & BUSHELM, KARTE_20050322

LICAMA / ❑ DREDGE & FILL
GENERAL PERMIT
C1New EModification ]Complete Reissue
Previous permit #
OPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment
and Natural Resour es
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A CAC
`. Yr , ( .�.� t ` .
r] Rules attached.
Applicant Name
Project Location: County
Address / , ` r " i
Street Address/ State Road/ Lot #(s)
City u% :. State .'/ ZIP
-�' r ----- -- — -- --
Phone # (�) ' i ; �` .' Fax # ( ) -
Subdivision -
Authorized Agent r/
City — ZIP
Affected CW _ i EW Ei PTA ICE§ ❑ PTS
Phone # ( ) River Basin
AEC(s): OEA ElHHF ❑ IH El USA ❑ N/A
Adj. Wtr. Body ———__----_ nat ]man Junkn
J 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) i —
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
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 Applicant Printed Name
-
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
rJ�
(Scale: )
!: -
C See note on back regarding River Basin rules.
.f
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction 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:
Tar - Pamlico River Basin Buffer Rules I_ , 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 If
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.nccoastaimanagement.net
Revised 10/05/01

ADJACENT RIPARIAN PROPERTY0�'�'�ER STATEi�'IENT'-
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a5 a d�9 /r
1 1��' & ee
I hereby certify that I own property 2djacent to `� � j �� r �' s
ff 1 (Name of PropertyOwner)
(ref /S L,)
properl}
located at � ��� � 7 b' 4`
(Lot, Bloch,
i Road, etc,) Ofi7cr�mlleo
(Ce-elQ �, �01. N.C.on ,
(Waterbody) (Town and/or County)
He has described to me zs shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
I� I'MOR DRAWING OF PROPOSED DEVELOPIMENT
DESCRIPTION A
(To be filled in by individual proposing deV
pm nl) 1 � wS'�
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Signature
Print o: Type Name
Telephone Number
Date: r � —v

2005/04/14 10:08:50
** NOTIFICATION & STATUS REPORT **
Pages1/1
DATE/TIME REMOTE CSID
Thu, 14 Apr 2005 08:27:26
DURATION PAGES STATUS
00:49 1 New
04/14/05 06:42 fAl
ADJACENT PJPATtIAN PROPERTY Oj��IER STATEMENT
�Y1�7 e
I herzby' etrtif�' th2t I own property adjacent to dame or Pcoper tY wner)
Lil ef
property ]ocatzd at
o� ��Jh,,Jjge* creek
terbody)
(1,0t B d, etc.) w
{Torn pnd/or County)
hais progo5ing Pt that Ioxtion,
He has described to = as shown below', the davzlopr�ent
and, I have no objections to his prop05=1.
PTYQI�t Ah'7�fOR p ,�'S'ING OF PROPOSED DE�'ELC P*MEN7
iSCRI
(TO Witted lled in by Zrtdiyidr�al prapotrr., de}
kd Coed
1�
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Gr/j� r
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e L
Print o- T ypz 1\En
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Teepho:r Number
-29-

21/2005 13:46 FAX [phone]
uar�arva io• r'na
AI)JA.CEINT RIPARIAN FROPERTY
(Fame of Propart}• 0-•ner)
T hereby cerff)- th?, I own property adjacenr to
ro rty 10med at
is- �lclfwe
le, 9/ 'PJ '� too e
ONyI1' P, STATEINIENT '
ff (Let, Block, Roza, etc.)
(Waterbody) (Town and(or Covnty)
2002
a uuz
He has deseribf!d to me as shvt� r� hclotiv, the development he is proposing at that Iocation,
and, I have no objections to his Proposal.
DE ;CRIPTION ANWOR IDAWING O)F PROPOSED DEVELOPMENT
(To be filled in by iRdividr�al propotirgdeltivpment) �(���D
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4/21/2005 13:45 FAX [phone]
Z 001
•- " Legacy Diagnostic Services
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DATE: 4 - Z_l _ `Q '5'
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Organimttion/Dept:
FAX Number
FROM: Name:
NUMBER OF PAGES:
(including cover sheet)
Organization/Dept: Legacy Imaging Services - Meridian Park Hospital
1.9300 SW 650 Avenue
Tualatin, OIL 97062
Phone Number: 503-692-7447
FAX Number: 503-692-2476
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FIRST CITIZENS BANK
SAYBORO, N.C. 28515 0 O
WHITTAKER CREEK YACHT HARBOR INC
STORE ACCOUNT 55-30/531
PO BOX 357 471
ORIENTAL, NC 28571 3/22/2005
PAY TO THE N.C.D.E.N.R.
ORDER OF
$ **100.00
Oneiiluldred and 00/100*ss*s*ssssss*sssss********3**ss**sssssssss*ssssss***ssssss+�sssssss*ssssss***ssss*.s*s****
N.C.D.E.N.R.
DOLLARS
MEMO
114000160112