37683_FENDER, DICK_20040512

L CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
EI.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 I SA NCAC
Previous permit #
Date previous permit issued
X Rules attach(
Applicant Name
Project Location: County
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Address
Street Address/ State Road/ Lot #(s)
City ! D ,I'
State ZIP + `+ ) 0
Phone # O i °-r
- ' 2 Fax # (�)
Subdivision
Authorized Agent
City ! .'.:,, ,
P-
ZIP_
J CW
EW "❑ PTA ES PTS
Phone # ( )
River Basin
-• , ,"
Affected
❑ OEA
AEC(s):
HHF ❑ IH ❑ UBA ❑ N/A
? — f
Adj. Wtr. Body , �;,, r
(nat /man /unkn )
❑ PWS:
❑FC:
Closest Maj. Wtr. Body -
�'".� �•
ORW: yes / no
PNA yes / no -) Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length_
Platform(s)
Finger pier(s) _
Groin length
number
Bulkhead/ Riprap length ___
avg distance offshore_
max distance offshore _
Basin, channel
cubic yards____
i
Boat ramp
Boathouse/ Boatlift[; k r
Beach
Other Bulldozin
Shoreline Length
SAM 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 comp�statem—eftonbackof permit"
i
Application Fee(s) Check #
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(Scale: .,, )
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See note on back regarding River Basin rules.
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 [)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 / 1-888-4RCOAST
Fax: [phone]
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)
Morehead City District Wilmington District
151-B Hwy. 24 127 Cardinal Drive Ext.
Hestron Plaza II Wilmington, NC 28405-3845
Morehead City, NC 28557 910-395-3900
202-808-2808 Fax:[phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves: Carteret, Craven, Onslow -above Onslow -below New River Inlet- and
New River Inlet- and Pamlico Counties) Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01