O'Brien, Kevin

br AMA / ❑ DREDGE & FILL -�
GENERAL PERMIT Previous permit#
I2154ew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources "]// / -)` o6
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / !
i3Rules attached.
Applicant Name -" '1� TT ,/'� (f `" ' Project Location: CountyGr�
kdress art / 1 l r k, ; / r e For
City f State"JC ZIP
Phone # (f_") j - i. Fax # ()
luthorized Agent r f ��t,
Affected i TdW ©EW 2 PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FQ
ORW: yes roa PyesNA no Crit.Hab. yes / no
1, .
Type of Project/ Activity 4.7 { �' U r J U e
Piar ( 1
Street Address/
/ State Road/ Lot #(s)
Subdivision
City '- ,M r �<..,J (3 ZIP
Phone # ( ) River Basin
Adj. Wtr. Body / f C t, Jy t C (r at, an /unkn)
Closest Maj. Wtr. Body ��'� `'' > ,' "�
(Scale: r„ -1 f )
ir pier(s)���■■■■■l.B9
�■■�■■■■■■il
SOMEONE
■■■■■r.■r�R■rrn■■■■■■■■■�•
■■■■■■■■r■
avg distance-
����:�r■:��Ca
::C■MCm'�
P111MIN�,�...■.
max distance offshore
■■■■■r�■■■■■■tea■■■r■■■�■■■■r■.c■r■■■■■■■■■■
cubic yards
■■.
■■■■■■■■■............�......��
...
ramp
-1 Bulldozing
......■.....■.■...■..■....�C.■.....■.
■■■■■■■■■■■■rya■■■i■■■■r■■■
■■
■■■■■■■■■
■■■rig■Sr
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Inotsure
■�■■C■■■C■■■■■■.■■
MEN
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yes
■..■■.■■..�■.r.■.....■■.■.■�C■■■■■■■O.
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■WITAN
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ts: yes
ON
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sr Attached: yes .■■■■■■■■■■■■r�rllOra■■■■■■■■f�■■■■■■■■■�
r,•
A building permit may be required by:
Notes/ Special Conditions
❑ See note on back regardi%River Basin rules.
1CV ,-)
/ " {
I ,1 `� j ?�� (" r ^t nit C / "r I. it
agent or Applicant Printed Name i' ! Permit iced
{
Signature Please re ad compliance statement on back ofpermit *� Issuin Date
.�
pplicationFee(s) Chec #C2�' Local PianningJurisdiction Rover File Name

1
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 consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules
© Neuse River Basin Buffer Rules
0 Other:
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/ 1-888ARCOAST
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

• ;t
ADJACENT RIPA 'ti PROPERTY OWNER STATEMENT
(FOR A PIER/MOORINGPILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent toy 6 0 eA 's
(Name of Property Owner)
property located at / �� &-40S Uwe_ bl't 'e
(Lot, Block, Road, etc.)
(,/fie
on koly>-�. , in ��/'eLCG� y(�� N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address:
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
�I do not wish to waive
V I do wish to waive that setback requirement.
-----------------------------------------------------------------7-----------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�v
(Information for Property Owner Applying
for Permit)
72d-q 4/d,,«r C:
Mailing Address q,�f
4C li
City/State/Zip
?43 -7.1)i 0
Tele Nu
2m
Signature Date
re4,01c, Wat(
(Riparian Property Owner Information)
/r1 Signature
Print or Type Name
(zSz� i�3I k62y
Telephone Number
3 z
Date

ADJACENT RIPARIAIti PROPERTY OWNER STATEMENT
(FORA PIER/MOORINGPILINGSBBO�ATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 'C`«��,� is
(Name of Property Owner)
property located at -`7 � Z 4 C— P���� ,
(Lot, Block, Road, etc.)
on �i Pi S G.1-c VC , in :C� W- , N.C.
(Waterbody) (Town and/or County)
Applicant's phone#: )7,-77 -7 l Z d Mailing Address:
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
/I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
se
City/State/Zip
Telep one Number
Signature Date
(Riparian Property Owner Information)
Signature
fiL%YID _ A'D
Print or Type Name
3 33 d
Telephone Number
Date

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