33337D - Jackson

-.r 'CAMA / DREDGE & FILL 3333 1 D '
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
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC /Z or .
l]Rules attached.
Applicant Name hi)/ J/93k.[CrY1 Project Location: County ONS C C)
Address Z.3VS a' 3E/2/0Y Ed Street Address/State Road/ Lot#(s)
City /)77- Oi1O67 State N0-ZIP 0y7 74h 5-4
Phone#(9/O) SR�O 6,2 7-77fax#( ) - Subdivision
Authorized Agent ),41ZR6 // J2/U City !,CUE F 0( ZIP Z V5'S
CW kEW ,,*TA " ES r PTS Phone# ( _) River Basin
Affected
OEA 0 HHF 0 IH UBA L__N/A
AEC(s): PWS: ❑FC Adj. Wtr. Body 14AAI—"1.406 (14,4,4e (nat man nkn)
ORW: yes / no - PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body TOP5q/4 SU
Type of Project/Activity ADD GXJ47 LIFT 7V EX/37//vfa p/EI,,/pFo,.4.-
it
(Scale: / -2 C ')
Pier(dock)length
Platform(s) I �' f ' ' ' 1, ! I --
I _ I
Finger pier(s) 1 ( i ;..a I
Groin length I , Agg X 11
1
number 0 ! 0 _ r���Jc/SifN4 i s LO r Bulkhead/Riprap length 1 . L�4
avg distance offshore ,,,, I __.,
max distance offshoreY_ ! ` i I___ I 1
1. O i i
Basin,channel �� —_
i
__ _— . T .- _. . . .- - - 1 ------
cubic yards _ — _
Boat ramp — — — — ----._
'i[Q ---------- > r 6xI STiN4 l I
Boathouse/Boatlift ) /3a/3 _ , i
� is Car;�_rt�t
��q��1�� i' Aid So*TnAv
Beach Bulldozing IRli1
IIOther t
Shoreline Length l
SAV: not sureyes no .
; I - _ � ; i I
Sandbags: not sure yes no I + 1 --
Moratorium: n/a yes no _■MIMIIIIII■■ I ■ ',.1 i --
Photos: yes no i ��__� 1 k _ 1
Waiver Attached: yes no i 1 I i i I i i I , 1
A building permit may be required by: SLfrt C /751 L See note on back regarding River Basin rules.
Notes/Special Conditions M A V NOT EA Cr ./7 y Go tell I 01:r QANA-L O 7e CX Ls j i iv()
p/ER 1.-i4 r-I3t/AI . /,cJ/-//CH EUCrt /.S M4r'Q eccntIC 7//E
f__----.)
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Agent or Applicant Printed Name J Permit Officer's Signature
U. - 3 6 - 1-0 -a3
Signature **Please read compliance sta ement on back of permit's' Issuing Date Expiration Date
, .0(-) In 5C4 t r Gi l 3,2oa of
Application Fee(s) Check# Local Planning Jurisdiction rile 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:
1 I 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(252-946-648 I)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
733 2293/ I-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

• -E../1NSIC H I . rt iuv i-i UOMPUTER FORM
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:APPLICANT?gal : �I /I ___l� •
ADDITIONAL NAMES: 7/ Z�A✓y
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ACTIONIR4TION
DREDGE&FILL R:QUIRE 3-Z D-c>3 6
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DWTSION OF CO4ST4L M4' 4CEMENT
AliT4CENT RTP4RT4N PROPERTY OWNER NOTTFTC4TEONAV4TVF,R FORM
Name Of Individual Applying For Permit: .SO
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Address Of Property: 10 4,1-7 7
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(Lot or Street#, Street or Road, C- & County)
I hereby certify that I own property adjacent to the above-referenced property.
diidual
applying for this permit has described to tie as shown on the attached drawing
The inlopment
. they are proposing. A description or drawing, with dimensions, should be provided with this
letter. . .
I have no objections to this proposal.
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Management, 127 North Cardinal Drive Wilmin5on North Carolina
�2QQ within 10 dae of re�Pmt of hip n�ti P Nn rPcnnneP ;� -a 405 or call 910 39
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.)
t F I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
3- 03 17:54r
Signature Date •
L v eke, TAA O Edict c f'.r,'e 1( .> '�--V-
Print game `7h S+ - 5QrF C.1y
l c'-(4 - c 6© NcDENR
Telephone Number b.,r With Area Code Nonni cAROLINA Da.,nRT►•mNT OF
ENVIRONMENT AND NATURA`R`MOURCES

DIVIcION OF CO4ST4L M4N4GEMEN'T
• A DJ 4 CENT RIP 4RT 41 PROPERTY Q 'DER NQTIFIC M:ION1NV 4I'4'ER FORM
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Name Of Individual Applying For Permit: '� -
�Gt S 6v►
Address Of Property: 7 7
(Lot or Street#, Street or Roa , ity & County)
I hereby certify that I own ro p pe rty adjacent to the above-referenced property. The individual
applying for this permit has described to-the as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter. . .
/61 / I have no objections to this�proposal.
Tf you have objectinnc to what is hPlnv mm�ot r1 n1PcP a,r-itP +two
Manapm n 1�71`Trth C`arri Tliyi
Q e�nn .,f ( naetal
--�--� mal T�ry W�lmtnotnn
39()0 within 10 days of r=emtof thisnotice No response is considered the
if you have been notified by Certified Mail rP same no objection as
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, Lift or sandbags must set back a minimum distance of 15' from myarea ofaccess beu
riparian unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
K/1). ✓ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
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Sim tore /�
viz Date
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Print NameNcDEk,„IR •
Telephone 'Tmj�e With Area Code N
.. N``'`�'�� r ,� .�-c r� GRouN�,D�,aRrM=Nr OF
v3C 6r ( ENVIRONMENT AND NATURAL RSOUR:S

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r--c-an.pr . • - Look for blue background on the front of this check,and the foul eSafc. logo on back.If not to i sit,do not cash. '•ter
LIGHTHOUSE MARINE CONSTRUCTION
tl P.O. BOX 2532 910-328-4852ITY, NC
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SURF C1648
28445 .
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PAY ,;•
TO THE {� " DATE 3 - Z o -03 68-19/530 NC.'' '%
ii ORDER OF u N E 702 ;t�f
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