Westbrook, Leigh

;7 CAMA / ❑ DREDGE & FILL - U
GENERAL PERMIT w Previous permit#
ONew ❑Modification ❑Complete Reissue • 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
[NRules.attached.
'Applicant ' pp _. Project Location: County A Name i �� -� e (�,'W`s , ~ � �.� � ;�r (,..
�, Street Address/ State Road/ Lot #(s) ^ t' i i { - 1!i S• I
r
Addres �- I , ! r. l 1
'hone # ( ") Fax #
wthorized Aeent `f . t t"
Affected
AEC(s):
ORW:
❑ CW 11,12) EW p PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no,, PNA yes no
Y ..
Type of Project/ Activity i ./ , i '
Pier (dock) length
Platform(s)
Finger pier(s)_
Groin length -
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift,j
Beach Bulldo;ing
Other
Crit.Hab.
yes no:
C.
Subdivision
Clty ,, } ZIP
Phone # River Basin
Adj. Wtr. Body j '=1 , i 17. ' + (nat marlll /unkn)
Closest Mal. Wtr. Body —
'Shoreline Length -`'t""
�+
SAV: not sure yes' Kn�j
;
.Sandbags: not sure yes . no%-
I
{ t
�"
`Moratorium: n/a yes (�n-a
'Photos:yes
s.
`
Waiver Attached: r yes no
t
A building permit may be required by:�
I
Notes/ Special Conditions *<•�r
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(Scale: i i �, )
❑ See note on back regarding Jiver Basin rules.
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'Agent or Applicant Printed Name fJ
�,'TermiitkOfficer's Signature
In,
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Signature 'Please read compliance statement on back of permif *
Issuing Crate
Expiration Date
'ApplicationFee(s)
Check# '`
Local PlanningJurisdiction
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, certifythat 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/ 1-888-411COAST
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

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. e 6 r oa I:._
Address of Property: A r k '' 1� r�s G g S i Z-
(Lot or Street d, Street or Road, City & County)
6-
AppAeantphonet Mating Address:
r �► %�✓�c I_�d�/ f J'V� � ��
Cell )151-113- 074 !�
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. ° Jon or drawing with dimensions must be »rovided with this fetter.
AK\ I have no objections to this proposal. I have objections to this proposal.
Ifyou have objections to what Is being proposed, you must noutythe Dfvlston of Coastal Management
(DCM) In writing within 90 days or receipt of this notice. Contact information for DCM offices is
available at www.accoastahnangement neUcontacL dcm him or by calling 1-888.4RCOAST. No
response is considered the same as no objection if you have been notif/ed by CerWied Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, or Aft must be set back a
minimum distance of 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.)
l_ i do wish to waive the IV setback requirement. � rV�/�✓� ��— `�"
t do not wish to waive the IV setback requirement.
(Property Owner Information)
Sig nature
Print or�fype Nama
-
Mm11ng Address
Caylsfataop
Telephone Number
`11�113
Dais t
( art P erty wner Informs on) _
r
SI alure
��c
Pdnt or Typo Name
P. 6O 9}
MaiangAd lass
alc
Cay/statemo �7
—2-40 —1 l 7
Telephone umber
Zo 113
Date
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' CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONiWAIVER FORM
Name of Properly Owner.
►� (- I.4,e- /ash fir. P).- S L�,, q l lei � >
Address of Property: f
(Lot or Street #, Street or Road, City & County) /rdd
Applicant phone #: — —L o?. S .ILLU Mailing Address:
I hereby certify that 1 own property adjacent to the above referenced property. The individual
applying for this rmit has described to me as shown on the attached drawing_the development
they are proposin . A d scriotion or drawing with dimensions 'niust be provided with this letter.
e no objections to this proposal. I have objections to this proposal.
if you have objections to whatls being proposed, you must notifythe Dlvlslon of Coastal Management
(DCM) in writing within 10 days of recelpt of this notice. Contact Information for DCM offices is
available at www.nccoastaimangement.neHcontacLdcm htm or by calling 1-888.4RCOAST. No
response Is considered the same as no objection if you have been notified by Certified Mall.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of V from my area of riparian access unless waived by me. (if you wish to
waive the etbazdo
u must initial the appropriate blank below.)
ish to waive the 15' setback requiremenL
I do not wish to waive the IV setback requirement
(Pr p wn / r Information)
Signature
Print or pe Name -�
S Mailing Address
pks, ixa�zs)Z
Cily/Stata0p
2S���aS-c��1�•�
Telephone Number
91 ao 113
Date
,oKs,Nr- ag512
(Riparian Property Owner Inf a
Sig e
�.'� I..�T.ne 111ema •_
�Y W 21r6 1
Tel hone Number
Date
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