53630_CONNERS, JOANN_20090512

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❑ CAMA / � DREDGE & FILL �-Zti.a�c Sg
GO-NERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reiss 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
D Rules attached.
Applicant Name
Address
City _
State ZIP
Phone # O
Fax # O
Authorized Agent
LI CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
OEA
ElHHF ElIH ElUBA ❑ N/A
AEC(s):
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab, yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # ( )
Adj. Wtr. Body_ -
Closest Maj. Wtr. Body
ZIP
River Basin
(nat /man /unkn)
Type of Project/ Activity
(Scale: )
Pier (dock) length_
Platform(s) -'
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore—'
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length z
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
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rules.
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note
on back
regarding
River
Basin
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit,**
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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 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, certifythat 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 (252-946-648 [)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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILIIYGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to jn#dj� s
(Name of Property Owner)
property located at /j% 4/-SI? ! V90 D ekeW /v
(Lot, Block, Road, etc.) ,, t
on , in j(f �t.J ',e %1 /l% _ N • C, N.C.
( aterbody) (Town and/or County)
Applicant's phone #: Mailing Address: qa 4-- .4 ztem S (2 tD/?
f e w) �ie.�T, Iy , C, 2y-59 O
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.)
A� I do not wish to waive
1 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)
for Permit)
0e-
ailing Address ignature
City/State/Zip Print or Type Name
Telephone Number
Signature
Date
Telephone Number
4 —/� " 0�
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE"10ORING PILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to G In"In) C-04ile— i 's
(Name of Property Owner)
�-
property located at `1'� ClU t2 AJEW 3eClL! ,
(Lot, Block, Road, etc.)
on �PJh �� tl�G� —, in O %3Q %? , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Z3 - 677,ef Mailing Address: 4 Avre 01?
,C• u
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.)
41Da 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
for Permit)
Mailing Address
� , 2ew"i
G o
City/State/Zip
Telephone Number
Signature Date
(Riparian Property Owner Information)
SignaU Jr
Print or Type Name
252.- 637 _ 35 q�s
Telephone Number
5�- / / - o 1
Date

JESOSE C.RICE
§ag- Circle
PH. 252-229-4420
1987 GOOSE CREEK RD.
GR TS ORO, NC
PAY TO THE
ORDER OF
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66-7704/2531 4003
OB629154839
DATE eF
DOLLARS UJ«
State Employees' Credit Union®
Grantsboro, North Carolina
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