38869_LACEY, DOROTHY_20040628

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
'—New Modification CComplete 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
El Rules attached.
Applicant Name nco cli,y t d0 y Project Location: County
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Address 1•ln. V- " "r . E _ Street Address/ State Road/ Lot #(s)
City_ h o fir, + State rI ZIP
Phone # ( { =) � ` 031 Fax # ( )
Authorized Agent t � r I,^'- ; r. u r r S / f 9; -
Affected ❑ CW ❑ EW © PTA d ES 2 PTS
AEC(s): ❑ OEA - HHF ElIH ❑ USA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA / no Crit. Hab. yes / no
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body 1 (tat�man /unkn)
Closest Maj. Wtr. Body
NONE
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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
f.
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, certifythat this project is consistentwith 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

DOROTHY L. LACEY a?c� —009
205 STAR HILL DR.
CAPE CARTERET, NC 28584
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Dggcfh j L,. LAC-e i is
(Name of Property Owner)
property located at dy5 �fRR 0,tI iJe
(Lot, Block, Road, etc.)
on Pe'+J jj g OQ eN . C .
.e k , i n Cry k�.R�� Co , — Ci�(� 2 e Rai ,
('l aterbody) (Town and/or County)
SHe has described to me as shown below, the developmentshe is proposing at that location,
and, I have no objections to hteproposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signatur6
Print or Type Name
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Telephone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to &i,d7-IYY �� CK-2 is
(Name of Property Owner)
property located at J.��,o� U%Q
(Lot, Block, Road, etc.)
_
on? � 1 i'C-V CICEDL in CAKC CA K 1 Ek�/ ; C& XTEke-j , N.C.
(Waterbody) (Town and/or County)
SHe has described to me as shown below, the developmentshe is proposing at that location,
and, I have no objections to he&proposal.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AN-D/OR DRAWPgG OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
---------------------
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Print or Tyre
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Telephone Number
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