35233_EARHARDT, TOM_20031006

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�^ ❑ CAMA / ❑ DREDGE & FILL`
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 15A NCAC
❑ Rules attached.
Applicant Name L� 1`9 k ; ''t t t_ j: 1 ? Project Location: County -
Address ' "D Street Address/ State Road/ Lot #(s)
-.
City} - State ZIP —
Phone # (,) /<r Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected ElCW I] EW ❑ PTA ❑ ES ElPTS Phone # (— ) _ _ River Basin r
❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body ___ __ _ (nat /man -unkn)
❑ Pws: ❑ Fc:
Body
---
y, -
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. - --
Type of Project/ Activity
Pier (dock) length
. r
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length '?
avg distance offshore
max distance offshore
.a
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
t
Shoreline Length
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
Agent or Applicant Printed ame
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
See note on back regarding River Basin rules.
Permit OfficeT- Signaturb
Issuing Date E+ratidn Date r
Local Planning J urisdiction 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, 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
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-13 Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

BROOKS DAMNIM & MAMNE7
507 BAYIAEW OR PH. 252-728-6886 1302
HARKERS ISLAND, NC 28531
W 12461531
DATE M-5-03-
PAY
TO THE
ORDER OF—L $
A
Too d o
OLLARS
Morehead City, NO 28557
FOR
AV
11M00I AO 211, 1:0 S 3 L L 2 6 Co: 000 13 7 9 21IN

Adjacent Riparian Property Owner Statement
I hereby certify that I own property adjacent to C L- /�j f WE
(name of Property Owner)
property located at ANEW
(Lot, Block, Road, etc.) /
onin
(waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that
location, and I have no objections to his proposal.
Description and/or Drawing of proposed Development
(To be filled in by individual proposing development)
7
signature
Ge0 r e Z' A)I lkle
print or the name
telephone number
/o
date

Ii K I-- 1l L. I r4 L.
hli:":. )T Tied ff�, ts tat ;.I Own Property adjacent to
�rttlme of Propvty Clmipor:i
(Iot, RIoLk, Road, e,,C. i
on RV
(Tmm u0fov
13.i- ViT, -I -d miv:; 11), ko to rn,%�mr* .1bvrin WOW, the de'4 el Dpment ht; 6R, propfirflni, at that
10tstikM, -$411 hFV C t1f) Ob'106VWIS to WA PrOPOSOL
Drawing of prop used DelveiopmOIT-t
i,rilbi; ftlie4 14 by !mdlvidwdprf pusing devdiopmenj
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print oi, op4: ivm-op

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