33526D - Jackson

toCAMA / _.DREDGE & FILLAl i ii - 3Z n y
GENERAL PERMIT Previous permit#
)C
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 7 , I/Dv
Rules attached.
Applicant Name_ J tyykynny - Akt-Iic5J i" - Project Location: County ONSAki
Address i) / e 4-t 4/ vle_ Street Address/State Road/ Lot #(s) /c)`- (14 4' / .,,)
Cityf 71S ��VY State /1e, ZIP?(W
Phone#( ) Fax#( ) Subdivision //��
Authorized Agent 5 -",, A�.IR i City SNG l r RP�/�1J,/ ZIP c;44/66
Affected L CW UW lA DES ❑PTS Phone# ( ) River Basin 1,4,4,1-& QI¢K
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA N/A Adj.Wtr. Body_ �'}'�,t/- �'y►�Q-/)aE G f4A4na
❑ PWS: 7 FC: ,�/D Q
ORW: yes f no PNA yes / no Crit. Hab. yes / no Closest Maj.Wtr. Body /V�✓ I'1 (/�2
Type of Project/Activity 6valkwF4,) ./1/ -4/.n,f
(Scale:J,r yo I )
Pier(dock)length
Platform(s) i , f ram' ,
Finger pier(s) I j + ! 1
--r I
Groin length y' . j
umber 1 I 1(1khead/RiPt5aPieflth . IU r•,
avg distance offshore ?1 H—
Boatrampi f .r
_ .-.. . .
Boathouse/Boatlik I �' I L
r-
Beach Bulldozing j I ( R i # 1
j ` 1
Other i i i , -
Oil
r j . f rt— tdi i ! 1 , I .21 -
���!
. , 1 - mil
Shoreline Length f� lv-
SAV: not sure yes no
Sandbags: not sure yes no — 1111 411111111;1111
Moratorium: n/a yes no I j � +_ —
Photos: yes no -- 1Waiver Attached: yes no i - ,
A building permit may be required by: 0 VS/0 Iv CAD E. See note on back regarding River Basin rules.
Notes/Special Conditions
e p�-/N CG / A /1 i At Or/"
o plicant Printed Name Permit''_S' re
ature �"I`Please read compliance statement on back of permit** Issuing Date Expiration Date
i/)l }rtS/Li 6 . 5.i 6a ����
Application Fee(s) ) Gluck 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 252-264-390 I 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
9I 9 733 2293 / I-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 I0/05/01

�s __e l✓ t� it t l�I :N-n' U I _k .E' a Ri 'M
APPLICANT NAME: J i ( yVV.`r
ADDITIONAL NAMES:
AEC DESIG: r •I% PT- DEVELOP AREk_UU c PROD DESC: _
(Will only lair 6) —
l r� (w'�only take 1)
>
WORK: `- t'�
(Will only take 4)
MAID?:
(Will only take 4)
IMP: S 6 `I )° •
(will only take 6'
ACTION EXPIRATION
DREDGE&FILL REQUIRED: 0 )7-v G y- ))_v
CAMA MAJOR DE VE ,REQUIRED: 0 Go - D 7-u 3 o cl- ) ?—c) 3

P. 1
* * * COMMUNICATION RESULT REPORT ( JUL. 1.2003 11:05AM ) * * *
TTI NCDENR NIRO
•
PILE MODE OPTION ADDRESS (GROUP) RESULT PAGE
654 MEMORY TX 8-9103273475 OK P. 272
REASON FOR ERROR
E-1) HANG UP OR LINE FAIL E-2) BUSY
E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION
State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Michael F. Easley, Governor William G. Ross Jr., Secretary
FAX COVER SHEET
Date: 67_6 1,ci '' No. Of Pages:
To: ,..44444....NAL. From:
CO: CO: _
FAX # ! —3'f?5 FAX#: [phone]
REVYARKS:
127 Cardinal Drive Extension,Wilmington,N.C.28405-3545 Telephone[phone] Far(910)350-2004
An Equal Opportunity Affirmative Action Employer

State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Michael F. Easley, Governor William G. Ross Jr., Secretary
FAX COVER SHEET
Date: PY7_C1 I—c/ No. Of Pages: ?
To: Gt. v-eAktimgt From: G / it c
CO: CO:
FAX ! )3.� 7 —3 k-ny FAX#: [phone]
REMARKS:
•
127 Cardinal Drive Extension,Wilmington,N.C.28405-3845 Telephone[phone] Fax[phone]
An Equal Opportunity Affirmative Actibn Employer

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DIVISION-OF COASTAL MANAGEMENT
v, ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
_ _ __ _Name of Individual Applying For Permit: . , AA.wv,. S ��� 0�
Address of Property: /V4-L P r,
(Lot treet#, Street or Road)
A-',-a6t) t-11-1/ /17,,(° r • .
(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 description or drawing,with dimensions, should be provided with this letter.
- �s`Q� 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 bcka minimum distance of 15' from my area of riparian access-unless waived by me. Of
you wish to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement - a'k/ •
Si? y : I do not wish to waive the 15' setback requirement.
t_ilt>&14-- - It—I, g 1 IG2_ d3.
Sign Name s Date
S tts N I P- ow . T.T9r, -
Print Name will/T
-- - _ NCDENR__
• NORM GRouNA DEPARTMENT OF -'
_ ENVIRONMENT AND NATURAL RESOURCES
Telephone Number with Area Code
S:\cams\shells\riparianproperty.frm .

DIVISION OF COASTAL MANAGEMENT
y s 'ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: r_h rti" S ={e50d
Y
Address of Property: CaN P ( S t
(Lot or Street#, Street or Road)
Sxx__Arn ``itA'� ;ULL, Z$�Gv
(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 description or drawing,with dimensions, should be provided with this letter.
c ; 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: 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.
aLe-C -
Sign Name _ ' Date
•
(-171 / fe M 09-5e _ AT
Print Name M
Q/ //{� (J��f .I��j /G� /1/�� NCDENR
-- _ - / /0 -- s V� _,1.,.V1 V ' / I - NORiX GROUNA DEPARTMENT OF
ENVIRONMENT AND PLEURAL RESOURCES
Telephone Number with Area Code ; -
S:\cama\shells\riparianproperty.frm - - - --

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