35145D - Champion

fX1CAD/IA / DREDGE & FILL 3e� �5
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GENERAL PERMIT Previous permit#
DI
New Modification Complete Reissue 7Partial 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 7N /2 0 C) .
C Rules attached.
Applicant Name -Ron CharYl)]1 U!l Project Location: County a.(..< +A 15 ...)i C l -
Address / L /IG r i r 1 b r )VC.r - Street Address/State Road/Lot #(s) /02 6 r pan
City _'/oCdCn 3clith state i!�G ZIP2, SL-/(c2 If
Phone # ( ) Fax# ( ) Subdivision
Authorized Agent L1 S/; V A WN F _ City M(cd-r'y --tirmin ZIP .g$1-1-&.
Affected `]CW ! T`A 7 ES PTS Phone# ( ) River Basin L, f
( )kr r
❑OEA ❑HHF C IH UBA N/A
AEC s : Adj.Wtr. Body G r')Cc (nat man '/unkn)
E PWS: ❑FC:
•
ORW: yes / no PNA yes /Yrfo) Crit.Hab. yes / no Closest Maj.Wtr. Body ��
Type of Project/Activity �J PI I7t lI 0c7 t 1 I-17 +
(Scale: 1 i i= Z C )
Pier(dock)length 'I Co 1
Platform(s)(f? 1`1(131 p el�K
Finger pier(s) ' 8)t 1 b
Groin length '
number Isle 14
Bulkhead/Riprap length 13o A'r C A"`I 4 t—
avgdistanceoffshore L.:P 1
max distance offshore 1 2 1 X I' 1 X'
_t__
Basin,channel e%e.'
rX •,
cubic yards
16 Y
Boat ramp
r 1
Boathouse/Boatlift 12 x IS
Beach Bulldozing •
Other
P14r..-."--3 e_..._.-.-3,
L
Co I+ $u 1 k i1eittic l
Shoreline Length SU
SAV: not sure yes no Sh be eV., e
Sandbags: not sure yes no
Moratorium: n/a yes (
Photos: yes 6)
Waiver Attached: yes CO • ..' _1_.._ -_
A building permit may be required by: /sec l7 D/'f/ '/C>'.e") B['(« A 7 See note on back regarding River Basin rules.
Notes/Special Conditions Kt (1046/ 11 o1%16 of /) r/ /200 App�
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Li b 4 Va gN/9m... I - V - -`4
e or Applicant Printed qame Permit Officer's Signature
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/0/540 ! ,,/„./
Signatu **Please read compliance sta�tl/ement on back of permit** Issuing Date Expiration Date
I
. AoblicationFee(s1 Check#2.L Z.. 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 252-946-6481
Location: Fax: [phone] Fax: [phone]
(Serves:Camden,Chowan,Currituck, (Serves: Beaufort, Bertie, Hertford, Hyde,
Parker Lincoln Building
2728 Capital Blvd. Dare,Gates, Pasquotank and Perquimans Tyrrell and Washington Counties)
Counties)
Raleigh, NC 27604
733 2293 / 1 888 4RCOAST Morehead City District Wilmington District
Fax: [phone] 15 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: TOn Chain prof-
ADDITIONAL NAMES:
AEC DESIG: (k) DEVELOP AREA:_ .�j. PROJ DESC: P -
(Will only take 6) (Will only take 1)
WORK: 15- I2 x/s.
(Will only take 4)
MAINT:
(Will only take 4)
IMP: : �O
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: �efr/b3
CAMA MAJOR DEVEL REQUIRED: l D/ $7U3 // /6_''`f

DIVISIO_NL_OE1 QASTAI, 4ANAGFMFNT
ADJACENT_RIPARIAN_PRQPERTIQWNER NOTIFICATION/WAIVER FnRM
Name Of Individual Applying For Permit: c n Chant picn
Address Of Property: I (p T aivpt,n t r.
1- E / 641
(Lot or Street #, Street or Road, City & 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 description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
"Lyon have objections to what is being ropoc , pl_ eease write the Division of Coastal
Management,_122North Cardinal Drive,_.Wilmington North Carol ina7g405 or_ all 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, lift or sandbags 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.)
.1�.�� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
Print Name NCDENR
Telephone Number With Area Code NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

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