38825_ELLIS, HOWARD_20040601

F� CAMA / D DREDGE & FILL
GENE_ _ GENERAL PERMIT
Previous permit #
CNew `!Modification F.-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
—1 Rules attached.
Applicant Name ` Proi1ect Location: County
Address
City State
Phone # Fax #
Authorized Agent
Affected ElCW ❑ EW ❑ PTA ❑f5 ElPTS
AEC(s):
ElOEA ElHHF ❑ IH ElUBA El N/A
❑ PWS: ElFC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
ZIP
Street Address/ State Road/ Lot #(s)
Subdivision
City _ ZIP_
Phone # ( ) _ _ River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body
(nat /man /unkn)
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)
i
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
_....
avg distance offshore
max distance offshore
—)
Basin, channel
cubic yards_I
Boat ramp
..........__._�......
---_...---
-
Boathouse/ Boatlift
Beach Bulldozing
1 '
Other_
11-1
--
Shoreline Length"
--
— — -- `
- I
i
`
� I
N
SAM not sure yes I,P.
y
Sandbags: not sure yes fio ,
-
I
Moratorium: n/a yes �no
_
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
; UN"Y
�' See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
i/
Signature ** Please read compliance statement on back of permit
Permit Officer's Signature
Issuing Date
Expiration Date
Application Fee(s)
Check# Local Planningjurisdiction
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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar- Pamlico River Basin Buffer Rules ❑ Other:
�euse 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
Fax:[phone]
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)
Morehead City District
151-B 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

HOWARD AND CAROLYN ELLIS
NCDL 615889 NCDL 1774438
918 MURPHY FARM RD
MERRITT, NC 28556
252-745-3359
8935 it
/ 66-7704/2531
ale
a-dder o
119
State Employees' Credit Union
34 Neui Bern, North Carolina n
Jz11(
1:253 L77049i:086047978 81i' 8935

ADJAC ENT RWAKLAN YKUYEK' A U'VVINEK N'I'A' LMI N Y
I hereby certify that I own property adjacent topoWar44- Ck}� n EI III 's
(Name of Property Owner)
property located at �(� O k r'o � •/ V , /% e P-7 ,W Al C sZ g S5-6
L t, Mock, Road, etc /
on /� l ✓fir'' , in Pci I'�I 1 C O 6o , N.C.
(N'aterbody) (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 DEVELOPNIENT
(To be filled in by individual proposing development)
prD�",-)y ('
Sys
5 ✓I, H c.ee
S6C)-
GL rr'evi�ly
Pro,dto-4y
54or•-'e-'4-Z)b
/-r t° - r-a/),0 SJ
A e-AAA
Cf a TAXI yS
-q 1-6 /y h
%-4- Hv'-I'0t 4 r, l/ r S
Sicynature
Print or Type Name
(7�'6 � - Z/
S� rc- c�trt-er.�
fllesi
pro")e/--7`y d
/itG44 e I
1,70 0 *--o t
Telephone Number
Date: _4- - -2,,0 - _ G7 ��

ADJAC ENI' IUVAKIAN YKUFERI' Y U VViNEK
I hereby certify that I own property adjacent topOW'A'14Y Ce4h!V11y E- 1l tS 's
(Name of Property Owner)
property located at inn ./ f' Rol; 9 i Parr,` 14 A%C 2, 8.7S'4
/n (Lot, lock, Road, et .)
on
/� , in ,pQ jv4 { I C Q CEO , N.C.
l ✓fir
(ti'aterbody) (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 DEVELOPNIENT
(To be filled in by individual proposing development)
ptlz) P er y a
5P� H Ce`
s GJ t-
G l� t, e vi�/y
ProP4,04Y
GA A A
eC' a �4�r V "S
Ga r-d ly h
4-- HC> L✓q," r— l f i S
Signature
Print or Type Name
5" re. c " rrC$)gY
Prcy)e"I'y W
/LitC,44 e l
/`70 0 't—o r.
Z-�
Telephone Number
Date: .<1 / L�