58178_ERVIN, SANDE_20110714

_7CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
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
Applicant Name
Address
City
State ZIP
Phone # O
Fax # O
Authorized Agent
O CW
❑ EW ❑ PTA i] ES ❑ PTS
Affected
AEC(s): OEA
❑ HHF ❑ IH ❑ UBA El N/A
❑ PWS:
❑FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City #. kff.3 Tr� ZIP
Phone # ( r?) 7219- ' I'N River Basin
Adj. Wtr. Body ± 1n �� 4 (nat /man /unkn)
Closest Maj, Wtr. Body —
istanceoffshor-
distance offshore
yards
Boatlift
dozing_
.MEN-
No
0
MUSEUM
MEMOMMM
ME
ME
ME
MEN
ME
0
No
it
ME
MIKAMEMEMMUM
LIKE
4.001
aim
ME
ength
notsure yes no MEN 2MI WIN IN
not sure yes no Allow
yes no: IMMUNE
Agent or Applicant Printed Name PermitOfficer's Signature
Signature ** Please read compliance statement on back of permit ** Issuing Date
Application Fee(s)
Check # Local Planning Jurisdiction
Expiration Date
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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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)
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

r
Y U DVA
Harkers Island, NC 28
l! V U DOLLARS LS
w�HOVA IVP I
wachovia.com---
c6
FOR 4 3 3 0
;0 5 3000 2 L 9�: LO I L-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to '_Spg14-pE L . E-2t11 tj 's
(Name of Property Owner)
property located at 3 b
151
Block, Road, etc.)
on r7k5 l-! C�ion/ , in �,A(�lT� , 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/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. 11,
I do wish to waive that setback requirement.
-----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
HIV S i ALL I)- F'PVLoX . [ j0 ' of v1 N4 L. W W A t..(_.
Signature
Print or Type Name
%2C'- 3fz a
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTlBOATHOUSE)
I hereby certify that I own property adjacent to C [— �U ►.� I
(Name of Property Owner)
property located at , 03 �� u) 1,C �Ar F;e5 �'sc_,e�-nJD talc` 2F53�
(Lot, Block, Road, etc.)
on-Ga5r Na&L-t'� —�rA— in �AaMEREZ , 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/boatlift/boathouse must pe 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)
j. f4 s i A LL. APPRty-. 15 of 0 4 lilt. SL-A IJAI L
-------------------------------------------------- ------------ ---------------------------------------------
a�
* 17— . -'.1 �'-
Q_
Signatur
LPs[t[s rZ- I�osE
r
Print o e Name
o ra- .1.7-8 -.;t fi-b8'
Telephone Number
Date: 1f /11

�1 i1 t 4 � \ Y�- ��,,�f },i �� `, ` 1\1 �Il + w' ,�� ibab a•F.`�� ���4 .�\.
y,
•... �\ 7 fir l'� ♦ k' '� i
r• f¢ -1 `I,911 ,I ",.1 i d •�1 1 ,3< _ l ,�� I' ,\,...� k\� �:F ���•:��r 5. :��1+ _I F\ \.
41
LN
64
i r
\�•
'�''•4;� !• .��, !o. 1`.• :�,,� 1'l; �, ;y,�,;t. - --�� ^ r\•`�- - .fit -� �'�.
1lip
titi '/ t dil'11� l y \
IV
Jy 1 1

JEW
71

TJF
.f tlnY l°Y,
�-dPA
40
�'°� ie I��.r}+r} 1,Ip,kt% '♦ J. r rbi �t���/�,�a,�,.�`,y�+ V `r" '�.1+t�t q J'
"t . �yt1 i • t " _ �' it \ 4�.'�Jf -,k-, �r gJ!w`r i! �� � A ..� +7 y i.
r ` I r�;w8 r ' , �'+i. ,�'7+''''.t �i. �!"•. �..t.���jf �M '�; �ttq'�' '' ��'�i.� �'� � r
r • a +, ;� "a t , tJ • t ,1, v � i „ 1� . � � 'r t ��,', 3 r g ' ",' ,.`tit � �
it i � ? r' � ' �� ��•�,�,

xAW
M"T

i•:, it r - } � � fR �.1�n�r+n.iy�4p '- _
z
1\
r
g
1-1 *0
r
17
� a
S
OOE
Ao
VA
.��`.ry ; ' '*ih ¢•, < ,�' <lrrr i j.�.�r �5.,4°; i. � ?{�5'Tra�� ':�esy. J
oe

llf�
' L k �•
Ab
t
�� -:♦ r OFF
Yi \ \_!�/ X'' �`�_; `�- `\ 1�+ �' !' "�..•+ fir'
ojp­
lot
Ir
�;_�' \}+.a' ✓' ... \�._ - -'/� - \ �y\ '' _ � "rv��`,j`.\ ! \ � ` -�`! 4iC. �����. _ t'1 sited `'• •'`, .
1
s.. � � a< _ '� �� I 1 � � . per•'_; ~ I . _' �•A ! i <a r�, _� �.�d._"� ._--_

N Al Y
MAN
'Tj IV
517"
Iv
VV
A
v:

Fray S.aj �
tir
Fr iA�n Ads
)Oil