60329_ETHRIDGE, KEN_20120621

CiCAMA DREDGE &FILL
�No. 60329
GENERAL PERMIT Previous permit#
5New []Modification CComplete 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
ff ❑ Rules attached.
Applicant Name S� ,-, /`�' y` t=� ` Project Location: County
Address Street Address/ State Road/ Lot #(s)
City ) Ei ( State !�✓i ZIP
L a
Phone # () e ?'�i'" %�i Fax # ( ) Subdivision 6,1
i `
Authorized Agent City / 1 E �l ZIP - 6, a
D ] CW _ EW -©f'TA ❑ ES ❑ PTS Phone # ( ) River Basin "
Affected OEA ❑ HHF 0 IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body (nat ,ma unkn
- PWS: C'FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body_
Type of Project/ Activity
(Scale:
)
Pier (dock) length
Platform(s)
Finger
Groin
Bulk
Basin
Boat
Boat
Beac
Other
Shoreline
SAV:
Sand
Mora
Photos:
Waiver Attached. yes
A buildingpermit may be required bai
P Y 9 Y�
Notes/ Special Conditions
c"I ` See note on bac regarding
J /Q ,�k g
/! r t (.� ��l ,+° -� '�'^ 42-41461�
rules.
8 River Basin
I
I
pier(s)
length
i
number
I
I
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
. f
Application Fee(s) Check #
PermitOfficer s Signature
Issuing Dat Expiration Date
r,a
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 (910-796-7215) 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)

KENNETH P. ETHERIDGE NCDL 3585330 6� g7
BELINDA E. ETHERIDGE NCDL 4727857 � e6-519 5s1
P O BOX 8 PH 919-284-6088
KENLY, NC 27542 `sl2—.
Date
Pay to the IV(:P. 'A) /P j $ 200, 0CJ
Order of
wo dollars
HE GE
\BAC my NC 27542
For
1:053 L05936,: 200700 L L45tt' 06197 ,�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby ccrtify that I ov n property E.djacent t A '{- s
(Name of Prop-erty 0-11;l ri
property locat,�d at
on �o tie S�Gcii1� in �fT� � COYA4 N.C.
—�(Waterbody) (To-vn and/or County)
Applicant's phone #: Ji j (2315���2 Mailing Address: 1 ° 7
C-h�
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 property owner proposing development)
D rq-d e- rmo4tA'tol , kQs-f 4" 1oo yds.
d o c�ks a 4l kce r,+ +rz, + h raft w i r•� M a,r rat
ck "Y4 ,
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
I o 7 WM% Or.
Mailing Address
Ko tt
City/State/Zip
!2 101 (o? 1 S'06 2.
Telephone Number
Si nature Date
Sig ture
V
Print or Type me
Telephone Number
V/ /A //. ;?
Date
a-�sl

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L
n
(i'�i;aine ofproperly
property located at 1 o z WPI )L
(Lot, Ploe.la, Road, etc,)
on ��QI.1�L in Ca e�17e! — sa N.C.
(Waterbody) (Town andior Coulity
Applicant's phone #: �Q�3 �062 Mailing Address: l-,
121OLtL.ay C;ji4Z�SS"7
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 property owner proposing development)
444-1 11) 0 t4 � �
I� aALAJ ne
fy� N+eXL4
(Information for Property Owner Applying
for Permit)
/ o -7 In A10 Col .
Mailing Address
City/State/Zip
acq dal s��2
Telephone Number
1S /Z
Si nature Date
(Riparian Property Owner Information)
Signature
lam► L mgns,itw
Print or Type Name
252-2qb --SCoo
Telephone Number
l S� 12
Date

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