54336_ETHERIDGE, KEN_20090729

❑CA"X / ❑ DREDGE & FILL
r. GENE"L PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
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
a Rules
Applicant Name 1�. P n �_ -# L e - , tI,k. Project Location: County
Address?x. _
Street Address/ State Road/ Lot #(s)
t F
City Fr l { State_ ZIP z ?'�N L t c, rA
Previous permit #
Date previous permit issued
Phone # ( I") `/''"j - l 71 Fax # ( ) Subdivision ) ;,
Authorized Agent City i V • ;; 1. a ZIP
❑ CW ElEW Q PTA [-IESElPTS Phone # ( ) River Basin S. ,1 s ( .
Affected ElOEA ElHHF ElIH ElUBA El N/A AEC(s): Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
M ME
MEMOMME .■■■...■■■ NON
•
■�■■:_■■■■■■■■■■■
No
W"OMMM■
MM
■■■■■■■
■■E6r/■■■■■■■■■■■■■MEMO■■■■■O_szii■®cEl■MME
®■■■■■
■MCE■MONE
MEMMMo■■■■■■■E
MEMMEM
i"■■■■■■■■■■■■■�■■■
R
:■■■■■■■■■■
■■■■■■■■■■■.■■■UMMUMMMU.■■■■■■■■■■■■■■■■
IMMEMNrim
i�■ME
rire�1111M1��JEl�IIEM!lEEIIM�lIEEh�E3M!:
,.,ENEl•II"il
'�I�:JOii�■��I..�■■!�I■r���C::i®_:sObQ_Ei�■hiiiiliE■■■
E■■M■■■■■■��■■■■■■IEEE!■■M■■■■■■■■
■■M■■M■M■■■M■■■■■■■■■■E■
MORWOMMEN
ONEME ^'' �ME■E EN MEONE MO®■■■MMEMI■
■■iCE■■I■■■■■E®■i■■�i■E■E■■■E■■E■■■■■■ME
e, I f691 .
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature L2-4 IC5
Issuing Date Expiration bate
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, certifythatthis project is consistentwith 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 Citv 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

JUL-22-2009 07;31 From;ETHERIDGE ACE 9192843106 To;12522473330 P.2
AUG-26-oiJ09 16:31 Frum:DCM MHOC"fY 70:919192943106 PaAP2'4
f •.
ADJACENT RIPARIAN VROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent to A14 � �
(N ine of Property Owner) r
property located at 1-0i R ?— -
r
(Lot, Block, Road,, etc.) _ ..
on Sgkz�—' i,, C , N. _
(Waterbody) (Town and/or County)
Applicant's phone, #: q' I�4 7071 Mailing Address;
14e has dcsCribed to me, as shown below, the developmcrit he is proposing at that location, and, I
have no objections to his proposal,
DESCRIPTION AND/OR DRA'WINC: OF PIWPOSED DFVELOPNSNT;
(To kfilled in by property owner proposing development)
f3e-que S-0" 0(
l55 be I pp Q lot]? 7041er1 I
c Al 19 fi sad
---------------- ^--------- .----------------L---------__-__-L-----------1----------------
(lnformatiaa for Property Owner Applying (I iparian Prupe, OWner,lu�'ormation).`
for Permit) 11 /,
Mailing Address f
C:ityl5tate/�i �-
Telephone, Number
S
S gna ate
Print or a Name
252 - 22� -335
Velephone Numher
Darr.
49��

JUL-22-2009 07;31 From;ETHERIDGE ACE 9192843106 To;12522473330 P.3
AUG-26-P,002 16;31 Frora:DCM MI•IDG'I'Y 70:31919cp43106 Patir:c �I
N ,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to SY7 Is
(Name of Property Owner)
property located at0� f� IL , 6 �1 ���.
(Ld, Block, Road, etc.) - -
�Waterbody) {Tvwu and/or Counii-)
Applicant's phonc #: 9 lq 2-947o71 IYlailiixg p a b F
n1ifi N c, 27W
He has described to me, as shown below, the duvclopment he is proposing at that location, and, I
havc no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF rROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
Roque 51
0,c4L(
F
c
a
(Information for Property Owner Applying
for Permit)
,..P 0-.. Mailing Address
7 - --
'ZiA.
LI l4 h(� -FCO-0 /1%f 6 �oc /0 Ts
(Riparian Property Owuer information)
S i gnato ra
flY) !I
Print or Type Name
Telephone Nuriib 'Telephone Number
/d aoq
5igna re ate Date

KENNETH P. ETH
13ELINDA E. ETHE
P 0 BOX 8 PH 919-284
KENLY, NC 27542
P(Ir, to file
Order off
— /Z"Y- Z>
THE
fiM'LkGE
4�
For ANK
1:0 S 3 10593 C31: 200
5641
7-
66-593/531
Oat
$ 000,6, 0
Dollars
M