59784_ESSICK, DONALD_20120313

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue El Partial 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
Address
City State ZIP
Phone # ( } Fax # (_ )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (`) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
- )
Pier (dock) length
Platform(s)---
Fingerpier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
jI
Boathouse/ Boatlift ¢
Beach Bulldozing
Other
-'
_
T_
j
i
I
i
#1
-
1
-
I
I
I
Shoreline Length _
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no r
Photos: yes no _
I I
Waiver Attached: yes no
ik
A building permit Y e ermit may brequired b : 71 See note on back regarding River Basin rules.
9 Y
Notes/ Special Conditions
Agent or Applicant Printed Name
Permit Officer'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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

66-30/531
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16O,/Litadaws LY 252 2412$16
S'waHsboro, NC28584-7433
DATE
PAY TO THE,
ORDER OF--A/—a- _e Q1-A,
DOLLARS F::a
Firsnk
t Citizens
fstirstcltialp
i FOR
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Acplicant: Dj
Date: �7y
r
Describe below the HABITAT disturbances for the application. All values should match t 7e name, unl s of measure Cent
found in your Habitat code sheet.11
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp im acts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
bunt
redge ❑ Fill ❑ Both ❑ OtherX"
Dredge ❑ Fill ❑ Both ❑ Other ❑
bredge ❑ Fill ❑ Bolh ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ ' Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other Cl
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[ WAIVER FORM
Name of Property Owner: �0 a h a� !''/' G- 'r S S .C_ ter
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: �5 �-. c/2 J�/ram Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
-� I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal
Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.neticontact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
w the setback, you must initial the appropriate blank below.)
t� ✓ do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
rope O"r„ Jpformation)
Si natur
"�J S
Print or Type Name
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone Number
Date

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
Name of Property Owner: pU K� n LQ
Address of Property: q_ A D Lnr�
(Lot or Street #, Street or Road, City & County)
Applicant phone S 3 ) ,//- S'3,( 9 Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they 'are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal
Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement,neticontact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to
wawalhe setback, you must initial the appropriate blank below.)
4AVwish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Property Owngr Information)
G
Signature
Print or Type Name
, _
Mailing Address
b�y/Stale/Zip
Telepi one Nu er
Date
f j ��
-mil • a
Q��
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone Number
Date

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