39018D - Tickle

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'_'CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
'New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources 7
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC `///,/2-QJ
L i Rules attached.
Applicant Name •?G r ✓L, fy 7iC,/G Project Location: County ��� u-'
Address ;Juu/ N4:410 7(�C� �/� , �
Street Address/State Road/Lot#(s) 3aL - t rpm
City Lk)/v1 S � c - State (1 C ZIP Z`) / O(
Phone#('.30 7&5 ' ZioFax#( ) Subdivision -
Authorized Agent City O�ca ; 6 e ZIP agg4/L-,�/
❑CW '-,EW XTA DES ^PTS Phone# ( ) - River Basin lit 1-"-7 6-64-
Affected --
s O OEA HHF E IH O UBA N/A
AEC : Adj.Wtr. Body y -vier •_• (nat 0 unkn)
❑PWS: I FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body44)4-4-1
Type of Project/Activity /--c_ c / /fe / L)QC t= / f /GC,717ii4 [1oC•/( -
J (Scale: /'.20' )
Pier(dock)length — ' _ j
Platform(s) /.v X r 7 _._..r_... - G� -t�-� 1 -+I
Finger pier(s) /(p X g�
i
I i I _ LI . 1
Groin length --..r ._ - I i
number I I 2
Bulkhead/Riprap length i �` 1 i + --r 1
avg distance offshore j ; _I I I I _ ,_�-
max distance offshore f r - - I- {---} T- I
Basin,channel - I 4 T I T f I I 1
i
; 6
_, ____;__
cubic yards j i l 1
i
Boat ramp — • — - — 1 - - / i
I ! I
1 1
Boathouse/Boatlift 1 i 1
f
i =
Beach Bulldozing 1 I j
Other I — . 1 — i I I #
. y U ,- k/,r _ tfy i _
y i wl
14
Shoreline Length _ S0i- , ,
I j `— I
�/ �{, —
SAV: not sure yes no - ` I . / ,/ f v y .
— — i r -
Sandbags: not sure yes (no I I- Sys l I I
i
Moratorium: n/a yes /ltio i 1 i 1
Photos: yes o T • • I ,a��-
Waiver Attached: yes no i// c u�. - ,
A building permit may be required by: l7(ij /5//e 'C. 'c. 4- LI See note on back regarding River Basin rules.
Notes/Special Conditions be f L >`•'/7i 7 /cjycc-�- 7 6 ' 6 - A)Ce��,) .5-4,6..._-E(#1 o e-XC_cc 0/
Agent or Applicant hiked Name Permit Officer's Signature
?/. Signature lease read compliance statement on back of permit** Issuin?fie)
ration Date
$/0064 76'7/ jrer4 Ale 6rf,C A/O?o3/5 4
Application Fee(s) 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 27699-1 638 252-264-3901 252-946-648 I
Location: Fax: [phone] Fax: [phone]
Parker-Lincoln Building (Serves:Camden,Chowan,Currituck, (Serves: Beaufort,Bertie, Hertford, Hyde,
Dare,Gates, Pasquotank and Perquimans Tyrrell and Washington Counties)
2728 Capital Blvd. Counties)
Raleigh, NC 27604
9I 9 733 2293 / 1 888 4RCOAST Morehead City District Wilmington District
Fax: 9 19 733 I495 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

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: IQ flC 1 ti Ki e
ADDITIONAL NAMES:
AEC DESIG: v1J P DEVELOP AREA: _.O ( PROJ DESC: (7 -f 2-
(Will only take 6) (Will only take 1)
WORK: 0 (Z i )i1-1 .
(Will only take 4)
MALNT:
(Will only take 4)
IMP: 0\4 1 Z9(
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: 1471. 3, Nov 3)OLI ' .
CAMA MAJOR DEVEL REQUIRED: ( 6 y k1OV 3/ Utf

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State of North Carolina
County of t.k.,4)—e-R-
Pthe..4.L.PAILuAL7 Notary Public for said county and state, do hereby
certify that C Ott te_A and N(p
personally appeared before me this day and acknowledged the foregoing instrument.
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Witness my hand and official seal this the • 2O day of CiLt_itt.
. ,
(0flicia'
(Notary Public)
My Commission Expires 10 I2/ 7.43 0 cf
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NPIMCF 2(92)
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 'RA t„i b y A-,^t
Address of Property: 3D- r t t t r
(Lot or Street#, Street or Road)
OCeakJ Isk IJec L , &IC Br vs k.).)�C.�
(City and County)
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. A descr. tion or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
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.
WAIVER SECTION
I understand that a pier,dock, mooring pilings,breakwater,boat house or boat lift must be set
bck 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
if) 'I-ZS -‘;
Sign Na Date
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Print Name ' •
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Tele hone Number with Area Code NCDENR NcMEnr of
p ENVIRONMENT AND NATURAL RESOURCES
S:\cama\shells\riparianproperty.friii

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
A
Name of Individual Applying For Permit: A tJ 1 c_kl-
Address of Property: S D... ' ' l`�0 ro S+
(Lot or Street#, Street or Road)
C-eck.v`1 J- c eB.co�-c�. M� C �j rJ rvs L�% (�Z
(City and County)
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. A descri tion or drawing, with dimensions, should be provided with this letter.
. I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
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.
WAIVER SECTION
I understand that a.pier,dock, mooring pilings,breakwater,boat house or boat lift must be set
bck 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.)
VI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
51
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Sign Name Date
Print Name A:7A
76ti- -6 63 - 3 6 -- /-
Telephone Number with Area Code NCDENR N�, DME,or
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S:\camashells\riparianproperty.frmw,+«M�AND NATURAL RESOURCES
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Randt A. Tickle 66-112-531 7671
Millie H. Tickle
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gW BLANCH BANKING'AND TRUST COMPANY (, Ys� f( I 14.141
F, WII ISTON-SALEM,NORTH CAROLINA
1:053LO112L1: 5L1843924611' 7 7L