37506_HOUSTON, JOHN_20040209

17
❑ CAMA / ❑ DREDGE & FILL
GENERAL 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 : j. r i i rd, ti
AddressE
City 'its r• ! iE
State f-
ZIP i " t l I
Phone # (�i) S7G
i `a j
� S' ��� Eax # (_ )
-4 2Z-
Authorized Agent
�- 140 f
❑ CW
K EW ❑ PTA ❑ ES
❑ PTS
Affected
AEC(s): ❑ OEA
ElHHF ❑ IH ❑ UBA
❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no'
PNA yes / no Crit. Hab. yes / nc
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body PilP me, jP rCNo j (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/Activity Iv+a,„�fViuwt
(Scale: �� )
Pier (dock) length
Platform(s)
Finger
Basin
Boat
Othe
Shor
SAV:
Mo
Waiver Attached. yes {�o
See note on back regarding River Basin rules.
A building permit may be required by: �� r ❑
Notes/ Special Conditions /I IfT 1t 041414 A, rI /!i1/� J �
� I
11444
Groin
Bulk NO
Boat
Beac
Sand
Phot
pier(s)
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local PlanningJurisdidion 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
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

MUD BUCKET DREDGING, INC.
ATLANTIC BEACH CAUSEWAY NCDL 8039839
PO BOX 3355 PH(252)726-2191
ATLANTIC BEACH, NC 28512
3769
•c�� �f�,,, 66-30/531
Date "o`�� 133
Pay to the
Order of
Dollars 19 ._.
HRs-r CITIZENS 133
!!!'" BANK firsbPlrz,a Bank 8 Trust Company
1-1-Atland - 11 N C 28512
T-1
firstc ti ens.c I
Forte 7 p 375a , M�� 3 37So,
f:5 3 00 3 0�0 II"L606 7 3
II' 03769
01111. gi1r —111: GUARDIA10) SAFETY BLUE NDBL

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -7t7,Z75 _79 OS
's property
located at
_ / z I (2EWA4 G2'r on
(Lot, Block, Road, etc.)
`2'0�0c-
4 e c �S � 4h1/-/L-Q— _ in
N.C.
(Water Body) (Town and/or County) 285/Z
He has described to me as indicated below the development
'he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual proposing development.)
If1/-�111 _L��(19,1(C'� 1�°lhtl� (2 1W X 30 fjOQ'r LI f%i /�aL=A .
QEH►oJAL r�F 'Q`�/Q- Z�2� EIoTIA Of- 4 r _ TOTAL 3lo ev, �s
LL-
�- 7.
Date
cli
E-
S g ature zr
' J
Pr nt Name
V�v/4451
Phone u b

02/09/04 09:37 FAX [phone] ANESTHISIOLOGY Z 02
�X 252'72G keel le►' 91
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT DA0611110- lot.,
I hereby certify that I own property adjacent to _717-7-75 _790B I
�i
��11J pv�To�l 's property
L
located at I-zRoad, etc.) on
(Lot, Block,
fd090F 5ovN0 {�!�!� N . C .
4ece -r GJ4AN; ag'' in
Body)
(Town and/or County) '2-SS�-
(Water
He has describedttatmlocation1araideI havewnohobjectionsent
he is proposing a
to his proposal. I understand that a pier, pflings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
_ I do not wish to waive that setback requirement.
---'c I do wish to waive that setback requirement_
Descri tion and/or drawin of ro osed development:
individual proposing development.)
I (To be filled in by �1 GS' ,qaCq .
�'1/.�lfrtci14NLc �"ef'Val �F /a �2'cJ x 30 �°a� Cv.
t2�r•+ovac vt Avg?.Z%y' wry of SRO S - T -rAL 36 -
'
I _
/
'D12604? 1"49 ACV64
Ll
.I I
E,c . $oAr �90 ek i 1
s6"'aLL-
I
2O ' / S , --�—'
ws' 1
Signature
J Print Name
Date Phone Number