37258_HOLCOMB. WALLY_20040113

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CAMA / ❑ DREDGE & FILL
GENERAL 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 I SA NCAC
IG�o
Previous permit #
Date previous permit issued
/ [jd Rules attached.
Applicant Name M4 Mi
I I,,, " 1" Project Location: County („- f s r .r
Address j '( j�; ( r c j f Street Address/ State Road/ Lot #(s)
City Ile State 'J ( ZIP (1 L :
Phone #
Paxi#
Subdivision e to
Authorized Agent
City ^/° �^' � '
_ ZIP
' f S 7
] CW
EW
❑ PTA
❑ ES ❑ PTS
Phone # ( ) S
)1 rf River Basin
V4 a %
Affected
C OEA
AEC(s):
❑ HHF
C IH
❑ USA ❑ N/A
Adj. Wtr. Body
(nat .man unkn)
❑ PWS:
❑ FC:
Closest Maj. Wtr. Body
ORW: yes / no
PNA
yes / no
Crit. Hab. yes / no
Type of Project/ Activity -1 7 I
(Scale:
Pier (dock) length E F i _.—___.
Platform(s) t
Finger pier(s)
Groin length
number -- —� — --- — -
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
i
Basin, channel-- ---
cubic yards °
Boat ramp /-� 41
Boathouse/ Boatlift
Beach Bulldozing
Other
cc
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no - - — 11 d wi (.
Moratorium: n/a yes no
Photos: yes no,
Waiver Attached: yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
)
Application Fee(s) Check #
(//ll
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 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 / I-888-4RCOAST
Fax: [phone]
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.nccoastaimanagement.net
Revised 10/05/01

S. WALLY HOLCOMB 1371
MARCIA V HOLCOMB
5020 Center Rd 66-162
Jonesville, NC 28642 _ ° ° Datea"�BRANCH74"0�'
Pay, to tile
order of
_Dollars
WACHOVIA
Wachovia Bank, N.A.
ACH Rrr 053101626
or F"�r� �7LSp
1:053 LO L6 2D: LO LOOS 497

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to5 L'-la`s �,/[ is
(Name of Property Owner)
property located at
on
(Waterbody)
/ l 6c,tcf r Ur •.
(Lot, Block, Road, etc.)
in /V,=t
(Town and/or County)
0
, N.C.
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
_ I do not wish to waive the setback requirement.
I d4 wish to waive that setback requirement.
-------------------------------------------------- 7---------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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-------------------------------------------------------------------------------- ---------------------------------
Signature
Moe �
Print or Type Name
Telephone Number
Date: 2--

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to S��`% �(�� a��i 's
(Name of Property caner)
property located at
on 1 L w
(Waterbody)
z-, n 111
(Lot, Bloc , Road, de.)
0
in Hey,, /ov—f , N.C.
(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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
*I " wish to waive that setback requirement.
Al
_--------------------------------------------
DESCRIPTION AND/OR DRAW NG OF PROPOSED DEVELOPMENT:
(To be filled in by indi idual proposing development)
----------------------------------------------------
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Si ature
NA P�����
Print or Type Name
Telephone Number
Date: a `v ��

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