41329_ZIMMERMAN, JOHN_20050429 (2)

,LAMADREDGE & FILL
1� � 41329 C
GENERAL PERMIT
Previous permit #
ew Modification "Complete Reissue -Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
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and the Coastal Resources Commission in an area of environmental concern pursuant
to I SA NCAC
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Applicant Name O"lam 7— ✓`� �yy`��
Project Location:
ules attached.
County C%�;i'"
Address 03— /via�GC . t f 64
Street Address/ State�Ro/ad/ Lot #(s)
City CejAr PotA- StateVCZIP � `�
l CS
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Phone # () Fax # ()
Subdivision
Authorized Agent
City CE ( /I
/' Pa r A ZIP
Affected ❑ CW ❑ EW ETA ❑ ES ❑ PTS
Phone # O
River Basin C,�
ElOEA ElHHF ElIH ElUBA [I N/A AEC(s):
Adj. Wtr. Body
©n t--C U `'t r`-✓ na man unkn
❑PWS: ❑FC:
ORW: yes no PNA yes / Crit. Hab. yes / (ijo
Closest Wtr.
Body
Type of Project/ Activity A J d X J C
/Maj.
J t! ,' (� t
(Scale: /t/
Pier (dock) length %.
Platform(s)
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__..._. -
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Finger pier(s)
Groin length
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number
Bulkhead/ Riprap length
c(-
avg distance offshore
distance
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max offshore
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Basin, channel
cubic yards
Boat ramp
Boathouse Boatlif
Beach Bulldozing
Other
Shoreline Length �/OC
SAV: not sure yes no
Sandbags: not sure yes no �(U
Moratorium: n/a yes _ ( /
Photos: yes n ` ✓� �1 �5�
Waiver Attached: yes - - - - - - -- -- -- - -- -- -- ---
A building permit may be required by: L CA- it'/C- l - U FL —See note on- back regrd ng River Basin rules.
Notes/ Special Conditions �'� Prr`�i .� ����'`''" Z$-i ba,,w % % pi
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
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A—Ii—ri— P..teN Cherk #
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rerm incer s aignawre
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Issuing Date txpiration Date
C�a� 61�,
Local Planning Jurisdiction Rover File Name

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• ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ZV\*4 Z%r-%MC64irJIPW'
(Name of Property Owner)
property located at I v S W 0 a- a4-41 S Ll�
(Lot, Block, Road, etc.) CG-A all i N 'r
on V 4, � o v r o , in
(Waterbody)
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Cr,940Q- Qo Ir. r W C. z-s s84.
Cfw-.Vc.2 e,-r- C o u r+ -r m , N.C.
(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 " wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
---------------------------------------------------------------------------------- ---- -- -------------------
Sign- ure
Print Qf Type NAme
'i3 Iz$4
Telephone Number
Date: 04t I ?Z 1 1 d 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that Law* property adjacent to �i0, �� is
(Name of Property Owner)
property located at 3'S C—T ,�" �� ►� ,
(�, (Lot, Block, Road, etc.)
`y
on OlaVw. 50vV-10 in CC.'MT4.4a- C0vo.��r"l , 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/boadift/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.
1% I d4 wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
Z-e"n
--------------------------------
P -5f,cu #0, -
Signature 1
a 10 e ✓`
Print or Type Nam
- 60
Telephone Number
Date: ��,7,— 0

JOHN G ZIMMERMM
105 WEST MAGNCS CT
CEDAR POINT,
� (.�vr_ OAcd)
1046
CAP
Asset Management Account 65-320/550
Z� Z 0 O � BpACH 00006
Date
,Yollars
CODE
T
WACHOVTA SECi7RI
+� Wachovia BaO, N.A.
nv
For 4371977525ii' 1046
1:0 5 500 3 20 L';