37939D - Slapak

eir ,CAMA/-r!DREDGE & FILL
GgNERAL PERMIT Previous permit#
>'Z ' Kew EModification EComplete Reissue 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 ISA NCAC 7 W'. /,) Co- .
CJR6les attached.
Applicant Name FRAn10E 5 SI A PF4Y-- Project Location: County j�Ru^./SWIC(
Address j 6.3 3l'A ricyw, Ne D Street Address/State Road/Lot#(s) I.f V 7 6 f 4 5 /
City - 06, Ci_)gm.1 CA- State SC Zip c.)' 3
Phone # (`(o`i 3'1 / - '))C fax# ( ) Subdivision
Authorized Agent / - City (i1 IVSe 13.Q4( f' ZIP , 1/(
tif'CW SEW ril44A ❑ES ❑PTS Phone# ( ) River Basin L u rn6P2
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body C.4-NA I (nat 640unkn)
❑PWS: ❑FC: �
ORW: yes / no PNA yes /`nn92 Crit. Hab. yes / no Closest Maj.Wtr. Body �rAt-AA)IA.)
Type of Project/Activity ei?,f Lit1/4. 0 t'!r/Z
, (Scale: / '=,o )
Pier(dock)length y t X 1
i ■■ i 1Platform(s) ---i---r_— -t l . t-
, ;
Finger pier(s) I � i
,tiA
Groin length ■■ `_ 1 ■■■■■
number L ■ it ■■■■
Bulkhead/Riprap length —I--- �� r .„.; , / •• P.- 1 T ■■ ■
■ ■ _.
avg distance offshore ` ■ -
•
max distance offshore ! , .■■
Basin,channel _
cubic yards — --'" i 1
Boat ramp — - I
I ■ ' ■ ._.
.
Boathouse/Boatlift _—'
' 'Irs-mwrim - is= 4 • ,_ ' .1 t f j j
-
Beach Bulldozing
Other I
� �� � �f � � I♦ '
i — ■■ EMU. 1 ■■■ ■■
, , I U.N .
Shoreline Len h
SAV: not sure yes no - I u r.6 77 1
Sandbags: not sure yes no ■ i I'. t
i
Moratorium: n/a yes no —_1-11
■ rt f I
Photos: yes no I ■■ -■■■ ■ 1 ■■■ ■
Waiver Attached: yes no - 1 ' i 1 I
A building permit may be required by: S1.44.51.f Reef(/1 . E See note on back regarding River Basin rules.
Notes/Special Conditions w'tf( ,`SA ige4C 7 11 ,/c.)-4 S (pi) P,er 5,4141/ No A tF 4,0 1,4r-YoAit) 1
p l�A(Pti-1 Pi PR % lt oR viO1 f Dr n f i�4oDy, rNt ,r t,�Pr 1 S LPsc. /2 t i s c,11ct° ,1 r�e7J
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Agent or Applicant Printed Name PermitOAlcer's ignatur
GG//
Signature *"'Please read compliance statement on back of permit" Issuing Date Expiration Date
Q k \\LCI SUtiSey t f/
Application Fee(s) /p0, r_ Check# 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 I)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(910-395-3900)for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District Washington District
Mailing Address: 1367 U.S. 17 South 943 Washington Square Mall
1638 Mail Service Center Elizabeth City, NC 27909 Washington, NC 27889
Raleigh, NC 27699-1638 252-264-3901 252-946-648 I
Location: Fax: [phone] Fax: [phone]
(Serves: Camden,Chowan,Currituck, (Serves: Beaufort, Bertie, Hertford, Hyde,
Parker Lincoln Building
Dare,Gates,Pasquotank and Perquimans Tyrrell and Washington Counties)
2728 Capital Blvd. Counties)
Raleigh, NC 27604
9I9-733 2293 / 1 888 4RCOAST Morehead City District Wilmington District
Fax: [phone] I5 I-B Hwy. 24 127 Cardinal Drive Ext.
Hestron Plaza II Wilmington, NC 28405-3845
Morehead City, NC 28557 910-395-3900
202-808-2808 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Carteret,Craven,Onslow-above Onslow-below New River Inlet-and
New River Inlet-and Pamlico Counties) Pender Counties)
www.nccoastalmanagement.net Revised 10/05/01

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DIVISION OF COASTAL_ MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: VmLCe _..SIQTQ
Address of Property: ()_l_- e : ._._.._.
443u_. 1 �e _._B_eaC..V\ ...SIC z `16
. • (Lot or Street 4#, Street or Road, City v� County)
I hereby certify that I own property adjacent to the above-
referenced property. The individual applying for- this permit has
,deirscribed to me as shown on the attached drawing the development_ they
are prrpossing. A description or drawing, with dimensions, should be
provi d _d with this letter.
I have no objectives to this proposal .
I_f_ you }'lave_ objections- to, what -is bein-g pr•opossed, please write the
Division of Coastal Management., 127 Cardinal Drive E:> tenri on,;
Wilmington, NC 28405 or call 910-39 5-•.3900 within 10 days of receipt of
this notice. No-response is- considered the same as no objection if
you have been notified -by certified mail .
WAIVEER SECTION
6
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be sat back a mini mum distance of 1 5'
from my area of riparian access unless waived by me. ( If you wish to
waive the setback, yo(..( must initial the appropriate blank below. )
_ I do wish to waive the :15' setback requirement.
I do not wish to
waive the 1.5' setback requirement.
•
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Si gnat(_(r Date?/
Print Name
Telephone Number with Area Code

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SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
.A. Re: e• =y(Please Print Clearly) B. Date of Delivery
ii Complete items 1,2,and 3 Also completeLz
item 4 if Restricted Delivery is.desired.. - �1.1�.
• Print your-name and address on the reverse ,Signature
so that we can-return the card to'you. ®0" 0 Agent
•
• Attach this card to the back of the mailpiece, X �� 0 Addressee
or on the front if space permits. D. Is delivery address different from item 1? 0 Yes
• 1. Article Addressed to: If YES,enter delivery address below: ❑No
\sE \--\o ask k\ A
s`e Ve(LC) ' 3.rice Type
bCe ei n Y�Certified Mail 0 Express Mail
2_141(g'l
cp ❑Registered Return Receipt for Merchandise
0 Insured Mail C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article 7002 0860 0005 3217 1286
Domestic Return Receipt 102595.00-M
PS Form 3811,July 1999
--- - --- - - - +
•
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1-,2,'and'3.Also.complete A. Received by(Please Print Clearly) B. sate;•f Delivery
item 4 if Restricted Delivery is desired. AIL r Qt ;A
• Print your name and address on the reverse C. signature
so that we can return-the card to you. ❑Agent
• Attach this card to the back of the mailpiece, X 0 Addressee
or on the front if space permits.
D. Is deliv rfe&.add different from item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
B 0.A--eXor\a A,
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3. Service Type
Certified Mail 0 Express Mail
0 Registered Return Receipt for Merchandise
/'' --:---- 0 Insured Mail ID C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Art' 7002 0860 0005 3217 1293
PS Form 3811,July 1999 Domestic Return Receipt 102595.00-M•0952

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