41756_WILLIS, JAN & PHILLIPS, JOHN_20050524

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CAMA / DREDGE & FILL 1116 16 G.
GENERAL PERMIT Previous permit#
'..^'New !Modification -iComplete Reissue ' JPartial Reissue Date previous per 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 I SA NCAC / �'
! F❑ Rules attached.
Applicant Name ' ! +> �" r��, � /'' Project Location: County C ^' i
Address % / / r/ L- -'� Street Address/ State Road/ Lot #(s)
r / `^ f
i
City- % `-. r a �^ , State ��' ZIP / / f fi // f/ l? L-� ,
Phone # ("z t---r / Fax # () Subdivision
Authorized Agent City ? " ";r �' _ _ ZIP
Affected
CW i EW p PTA ❑ ES ElPTS Phone # () River Basin
-
AEC(s): OEA ❑ HHF I- IH ElUBA El N/A Adj. Wtr. Body r l . (nat man (unkn)
=I PWS: i❑ FC: �Z i
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
Boathous-Boatlif ,
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
Signature Please read compliance statement on back of permit
cc. GCS 't)411
Application Fee(s) Check #
(Scale:
-- - -L -- --- - 1— - -- --
__ See note on back regarding River Basin rules.
Permit Officer's Signature -- ��
Issuing Dat 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:
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

` ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to San \N im's/ J Ol�hn 1��>>'�p�s
jS� 31 'i (Name of Property Owner)
S
propertXcated at
4' i 5 1-+011.4 In n .
(Lot, Block, Road, etc.)
on �C o,u-2_ sour' , in NA O cekrmcl L.i +i , N.C.
(.Wa rbody) (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.
--------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Soljd��
Signature
/—//V CGG"V
Print or Type Name
Telephone Number
Date:i2 -2-/0,,!9-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �J hn ��; i �,'r,� iav-M i (` j S 's
(Name of Property Owner)
propc;t� located at 013 i 611y L.h - '-4� Q (5 �-�-o j I y L n
(Lot, Block, Road, etc.)
on S62, Lkk S o n , in bA () r e� A C- �/ , N.C.
aterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(To be filled in by individual proposing development)
C'I'G.P— CDC-
"�
ZS'L-?_-tD -/3S0
Telephone Number
Date: Z- Z- — 0

ADJACENT RIPARIAN PROPERTY OWNER srATIIMENr
(FOR A FIERIUNCOVERED BOAT LIF7)
I hereby certify 'that I own property adjacent to - r--c,,- i�,�,l t 'S
erne of (N Property Owner)
property located at
(Lot, Mck, Road, etc.)
on , in o , N. C.
aterbody) (Town and/or Cou ty)
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/uncovered boat lift
must be set back a minimum distance of fifteen feet (IS') from my area unless
waived by me.
I do pot wish to waive the setback requirement. MAY 2 3 2005
L _ I da wish to waive that setback requirement.
Morehead City DCM
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
` z2 - CoOgF-11
Telephone Number
Date: 2�w Z5. Zoo

•
1306alE sounib PC�?j�
�x s 2005
it' 19'
Morehead City DCM
�M

3442
JOHN H. & SANDRA PHILLIPS
Ph 252-726-4577 66-211530
4913 Holly Ln Z BRANCH 77614
Morehead City, NC 28557
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Pay to the [Do.
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Dollars
WACHO nL�1�5�
Wachovia Bank, N.A. 1 1
wachovia.com
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