36687_HOLTON, KEN_20031030

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❑LAMA / _ DREDGE & FILL
C E IV E FOAL 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
Address
City
Phone # ( ) _
Authorized Agent
Affected ❑ cW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State
Fax # ( )
❑ EW ❑ PTA
❑ HHF ❑ IH
FC:
PNA yes / no
Type of Project/ Activity
Pier (dock) length
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes
no
Sandbags: not sure yes
no
V
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required
by:
Notes/ Special Conditions
ZIP
❑ ES ❑ PTS
UBA ❑ N/A
Crit. Hab. yes / no
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (_) _ River Basin
Adj. Wtr. Body (nat /man unkn
Closest Maj. Wtr. Body
(Scale:
0 See note on back regarding River Basin rules.
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 ElOther:
[ZNeuse 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 (252-946-648 I) or the Wilmington
Regional Office (9 I 0-395-3900) 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)
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

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COASTAL MARINE CONTRACTORS INC f1
PH.252-638-6407 --- _ _
PO BOX 12729 7012
NEW BERN, NC 28561-2729
PAY
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NEW BE RN, NORTH CAROLINA
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SEP-24-2003 WED 01:19 PM NO DIV OF COASTAL MGMNT FAX NO, 4 P, 07
OCT 2 0 2003
ADJACEYf PJPARi.�N PROPERTY OWNER STATE�MNT
(F01? A PIER/MOORING FILINGSIBOATT.IFI"IBOATHOCSI'
I hwrtby ce dfy that I Qwn property adjacent to L01j,"'ll� N r 11/�' i is
(Name of Prop,:rtv Owner)
proper,y Irate i at Z45 C %.-p.�jp11 'I/j
(Lot; Block, Road, etc.)
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on ��/��nl . I'� in N.C.
(W,7tcrbody) (Town and/or County)
He has desrnibed to me, as srown below, the deve!opme^t he is propos:-g a: that location,
and, I have no objections to his proposal. I ur,ecrszP—nd tr,a: a pie;/mooing,
p iir, w,boc liiz(boritllousr: must be k. back a minimum disrince of f��e4q fe,: (i;') from my arm
of ripanan accass unless waived by,Me.
__ I ,�Li Tint wish to waive the setback requiremient.
Y'Y I do wish to wa'vc t-ar setback requirement,
DESCRII✓'i'ION AYDU OR DRAWLNG OF PROPOSM DFVIELMt YT!-+-------
(TO be filled in by 111dividual proposing devetopment)
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' SEP-24-2003 WED 01:19 PM NO DIV OF COASTAL MGMNT FAX N0, 4 P. 06
ADJACEN U REPARUL PROPERTY OWINIR STATEMENT
(FOR A MERIMOORING ply YGSi80ATf.IFT/,8DATMOECSE)
OCT 2 0 2003
I hereby ce, ary that I own properry adjacent to � ��_�_f� �"'j—'s
(Name of Property Owner)
prone: v loc v'd at /f 50�1- r�.. '? ��h a- _
(Lot; Block, Woad, etc.} ��-
on _Ypf K `v-? .. ��. ..� in _7� G�c✓ /,�,2" N.C.
(Mater'body) (Yawn and/or Count,)
He has dexniJed to me, FS siown below, the develoLarm:'« he is prou0sini a- Chat location,
and, I have no objections to his proposal. I under--a7i'd Ens. a p d'-ImoormR
pu.ir��sicor:lirt�t�oa.5ous` must be c:: back a minimum dis►ance cif'fr-L 1 fw: (15') from my armti
or npa:«n access unless waived by ma.
to the se.bzc'.< reAuircn'�e::.
_, d� w'�s� to w�,tie t:-a►, serbzck rcc+irc•�enc.
'DF5CRIP'"iION' AN'D/0R D R A ""E G OF FR0PO5ED DEVELOP M'N-f:
('Co be filed i.: by indivlducc! proposing div&topmenr)
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