38388_FOSS, CREIG_20040619

CAMA / ❑ DREDGE & FILL N i
GENERAL PERMIT Previous permit #
❑New AModification Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources j
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ;
Rules attached. 3
Applicant Name
Address
City r�
Phone #
Authorized Agent
Affected —_ CW D EW
AEC(s): I OEA ❑ HHF
� PWS:
ORW: yes / no PNA
State ZIP c.
Fax#(ki
Permit
O PTA ❑ ES ❑ PTS
❑ IH ❑ UBA ❑ N/A
❑ FC:
yes /lno Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City a ZIP t, 7
Phone # (_ _ _) River Basin 1-
Adj. Wtr. Body I c tI u .i (nat /man /unkn)
Closest Maj. Wtr. Body `/, w,C
Type of Project/ Activity
i 1 0 i .. i. f"�:
( ` I � •�
r � " "1 l
♦ r ri l✓ r'� f ,
L: �'' � (Scale:
Pier (dock) length �% C'
Platform(s)
Bulk
Basin
Boat
Othe
Shor
SAV:
Sand
Phot
Waiver Attached. yes no
A building permit may be required by:
Notes/ Special Conditions
�
J �c
C See note
o.f rvgo� r)% f.�J—
on back regarding River Basin
rules.
}
f
ya
L
O�v • 4 ,� ram, .� P.•P v i�.. a a+ v
1
r pier(s)
I r E
n length - - - - -
number I, I
P P _ f
head/ Ri ra length ,� • I
avg distance offshore I
max distance offshore
channel .� , cubic yards74—
ramp r
I
house/ Boatlift � hf c v� -
_ r 6JIY(fl
h Bulldozing -
eline Length !'h • � +•-� + ` _ ��. �` . -
not sure yes no -
bags: not sure yes no
l y novt ,f� �►It atorium: n a es —F
os: yes no
Agent or Applicant P
r' ted Nan,
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Officer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
Agent or Applicant P
r' ted Nan,
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
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, 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 I 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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

CREIG FOSS
DEBORAH FOSS
NCDL 2884423 2734920
608 S. CHARLES ST. 919-566-4464
LA GRANGE, NC 28551
PAY TO E ,� ��
AY
Wachovia
Wachovia Bank & Trust Company, N.A.
LaGrange, NC 28551
CAP L mg
i:053LOL5291: 3358 89
L553�i' L412
1412
66-152/531
/Zol
_D O L L A

December 9, 2003
CAMA
Re: Proposal for Pier & Dock 4-1041
Lot # 30 Daisy Saunders Koonce, Tax Dept. Map I.D. # 539402995349000
I, Charles Crei Foss proposed to build a pier at this property site approximately w
g p P P� p p Y pp Y
feet long (whatever the distance is reaching the distance of the adjourning piers to the left
of this property, one being in the name of Richard Chapman). At the end of the pier I
propose building a deck approximately 16'XlW which will form a twith one boat lift on
each side of the deck. The adjourning property owners are listed below and are in
agreement with this proposal which be presented to CAMA.
Charles Creig Foss
Oz Coward
Danny Roberts R
Presenter
Adjourning Property Owner
Adjourning Property Owner
L

are in sections 4' X 10". Approximate length of
e plus or minus to string pulled from outside
iers.
Walk up Ramp
4' X 10