54690_BRISSON, DAVID_20091014

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
0
4691
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources }• j f�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC i1 j
attachfd. 3
Applicant Name 1 ,� r'� ) i t-;` T._ Project Location: County ; 7 ` ' r, r
Address__ 1-� �; ! -` }� Street Address/ State Road/ Lot #(s)
City �� �. State K ZIP
Phone # (ax # O Subdivision
;f
Authorized Agent ..... .� . . _ ,�.o,,. 1 a i �-0� City I i ZIPTr�
Affected ❑ CW ❑ EW [I PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no
❑ ES ❑ PTS Phone # O — •' '? ;1 River Basin
❑ UBA ❑ N/A Adj. Wtr. Body
Crit.Hab. yes / no Closest Maj. Wtr. Body —
Type of Project/ Activity
Pier (dock) length
Platform(s) —t - "-
---Finger pier(s)
(Scale: J J )
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
1
-41
I
�
-
-
i
Shoreline Length f
SAV: not sure yes no
f
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no j
Waiver Attached: yes no ! /
A building permit may be required by:
Notes/ Special Conditions
+
� `
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Permit Officer's Signature
t
Issuing Date Expiration Dat
," /)
ApplicationFee(s) Check# Local PlanningJurisdiction - Rover File Name

4
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 1) 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

i
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to is
(Name of Property gW_'
property located at
(Lot, Block, ad, etc.) U L l 12 1009
on --1 ,C��� �C,i.�� C , in v"[ y : (.I ity®VIYi
(Waterbody) (Town and/or Coun
�
Applicant's phone #:�: k ' �h2S, 1)C. `( Mailing Address: ���� +'�� /Lc.• �'tjt_�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
C�,,-x,�
Ice �b
___-_---____________________________________________________________________________________________________
/I L (Information for Property Owner Applying (Riparian Prope wner Information)
t � for Permit) —
n
i
Mailing Address J
S' turree
c; �C V -She rr ©. h t,,cJ "at-
City/State/Zip Print or T Name
1Lone NumberZ Telephone Number
Signature Date Date

R
ADJACENT RIPARIAN PROPERTY OWNER STATET t' �
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATHOU
S
DL t 1 h )fy)y
I hereby certify that I own property adjacent to �._ ,� s
(Name of Property eaCj C- r��A
property located at (-4-r 1.� �b!
(Lot, Block, ad, etc.)
C , in ��� < r f�� $vu nu , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:q : / 7 Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------------------------------------------------------------------------------------
/ (Information for Property Owner Applying (Riparian Property Owner Information)
i for Permit) LLU.Ac �
Mailing Address Signature
�� V �� _L t"x � � �V L - �- '` �7 �: l'r�Nl/Ri �� �r�� �i►i�J J �1�.t l-f�-
City/State/Zip Print or Type Name
1 I (i 25-2 - Z%Q-1.2p9
Trte kone Number Z Telephone Number
Signature Date Date

DAVID A OR EDIE D. BRISSON
NCDL 8201663 PH 919-788-3101
110 WALNUT CREEK DR
GOLDSBORO, NC 27534
Pay to the �
order of ^ j\ /
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2199
66-21/530
J BRANCH 77570
Date
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