Farnsworth, Rodney

CA/DREDGE &FILL akf 622276
GENERAL PERMIT Fro Previous permit #
2New ❑Modification ❑Complete Reiss ❑ rtial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -79 1 � G U
and the Coastal Resources Commission inanarea of environmental c ncern pursuant to I SA NCAC
QRules attached.
-Applicant Name it* r$ f n 4,1 C7i` �� Project Location: County
Address ° '� ► �' ` j Street Address/ State Road/ Lot #(s)
�City rr� r.:� c ^ State d ZIP ; % (� ! /3 Z I OAC' i «�
'hone# )� `�' Fax # (—),
kuthorized Agent.. . -1
Affected ❑ CW LaEW ,-tTOTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
❑ PWS: ❑FC:
ORW: yes / n� PNA yes / ' Crit.Hab. yes / no
Subdivision
City. cel-11c, T ,, .�.� „- ZIP If%U
Phone # ( ) River Basin <v 1 1r oi'1
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Closest Maj. Wtr. Body CO
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'Agent or Applicant Printed Name
Permitrff er's Signature
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Signature Please read compliance statement on back of permit
Issuin g Date -
Expiration Date
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Acati pplion Fee(s) Check # ''
Local Planning jurisdiction
Rover File Name
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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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F1 Tar- Pamlico River Basin Buffer Rules 0 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, Orislow -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

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ORIGINAL PROPERTY LINE ` ONES
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LEGEND
— — — — PREVIOUS BoUSM LINE
PROPERTY LINE
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NORMAL HIGH WATER UN
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A TMA...
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, secretary
Date (4O AZI 3
Applicant Name Cad IA
Mailing Address
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I certify that I have authorized (agent)'-�
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f rcti.c'c er
ot.Zc. to act on my
behalf, for the purpose of applying for and obtaining a�ll�CAMA Permits necessary to
install or construct (activity) r'r 14�vl�ee vt. t�cx CZe
at (location) C LN.&A Q Ir el i:�
CQ.CjC�.J' .1 0�
I
This certifi
•Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] l Internet: www.rtcCoastalmanagemeni.net
An Equal Opportunity 1 Affirmative action Employer 50% Recycled 110% Past Consumer Paper

DIVISION OF COASTAL, NIANAGEMENT
ADJACENT RIPARIAN PROPERTY 4 NE�OTIFICATIONIWAIVER FORM
Marne of Individual applying for Permit: �QLb� nr 4-k
-
Address of Propety : J
: r- e
Q _
{Lot or Street #, Strekor Road. Cky & County}
I hereby certify •that I own property adjacent to the above referenced property. The individual
applying for ihts:panydt has described to me as sham on the•attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this letter.
t have no objections to this prwosel.
ff you have objectlons to what Is being pposed, please wife the pJvlsfon of COOMW
Management 400 CommevwAvenue, Morehead City, N4 28W orcaN(2S2)-808-2808wNdn
f0 days of re al of #ris noifcer N©rs�spo»sa#s considered a sarrre asna ob, jecUen if�r_ou:
have been notified by Certfffed Mail. -
WAVER SECTION
I understand that pier, dock, mooring pilings, breakwater, boathouse. bgailift orsartc#bags must
be set back a minimum distance of 1.7 from my area of riparian access unless waived byme. Of
you wish to waive the setback, you must initial the approprfate blank below.}
i do wish to waive the 15 setback requ rement.
I do not wish to waive the 16 setback requirement.
(Applicant Information)
Uait+ng Addtess
A/-C' • 2-S-S 2
Glty/swazlp
Telephone Number
(Riparian Property owner Information)
LaA
Print or Type Nam
2s2.-Z2✓-/36G
Telephone Number

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN fRCPERTY 0 NE"QTIFICATIONPjYAIVER FORM
Name of Individual applying for Permit:
Address of Property:
W
r
L�
(Lot or Street #, StmAor Road. City R Cawity)
1 hereby certify -that I own property adjacent to the above referenced property. The Individual
applying for this.pannit has described to as shots on the.attached drawing the davetopment
they are proposing A description or drawing, with dimensions, should be provided with this letter.
V I have no objections to this prOpflsal.
if you have Objections to what Is being proposed, Please write the Qlvislon of Coastal
Management; 400 CommerceAvenue, Morehead City, NO, 28Worcall (x32).808-2808within
f0 days of recelpt of this notice. No mspommis considered the same as.no objectfon I -pa
have been notified by�ertiffear JEfall.
W"ER SECTION
I understand that a pier, dock, mooring pilings, bmakwatsr, boathouse, bQatiilt or-sand.begs must
beset back a minimum distance of l.7 from myarea of riparian access unless waived by rra. (If
you wish to waive the setback, you must initial the appropriate blank below)
I do wish to waive the W setback requ(rement f A Al
I do not wish to waive the 16 setback requirement
(Applicant Infonion)
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AWkVAdftss v
.N.(—' - 28.50
Gwawaqo
. G/7- (n86-1��/
Telephone Number
(Riparian Property er Infomation)
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PfintorT)pe Wame
Telephone Number
(f15-O�
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