38054_LACY, CHRIS & DALE_20040503

7CAMA / O DREDGE & FILL
GENERAL PERMIT
Previous permit #
GNew ❑Modification OComplete Reissue
J 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 4 i-�
Rules attached. �
Applicant Name_ s y 7a ►r 1 ar., --
Project Location: County !,
Address a r, - f w! P4 L
Street Address/ State Road/ Lot #(s) j
City 1`i cc, c fv 0 t State JC ZIP
_ f ! • rill
I
Phone # O E '14 Fax # O
Subdivision
Authorized Agent 44 7161I.-
City— _ ZIP 'c ►�
r CW O EW Z PTA ❑ ES - PTS
Affected
Phone # River Basin rV k
I OEA ❑ HHF ❑ IH ❑ UBA - N/A
AEC(s):
Adj. Wtr. Body * °r: r P�rc•r1r (1INi ► Lat:�an /unkn)
-1 PWS: ❑FC:
n
ORW: yes / no PNA yes / no Crit. Hab.
Closest Maj. Wtr. Body
yes / no
Type of Project/ Activity j)
b a fi �n v . (Scale: fv=�C )
Pier dock t
(dock) length gt � ��v�`--
,T _
Platform(s)_ I -
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards t�
Boat ramp
Boathouse/Boatlift knrc✓f>r
Beach Bulldozing
Other
-
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T
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Alf.
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P
Shoreline Length
SAV: not sure yes no ,..
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: (Ye no -
A building permit may be required by:
Notes/ Special Conditions
-
{
j
-- - -
on back regarding River Basin rules.
r.,
r
❑ See note
Nca
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
,ti' g 3 7 o C `/
Issuing Date Expiration Date
Local Planningf urisdiction
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 / 1-888-4RCOAST
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

SHORE THING CONSTRUCTION 03-04 1064
J. RYAN BAYSDEN
252-422-4183 66-19/530 NC
5 `G 201
3704 OXFORD CT. Date
MOREHEAD CffY, NC 28557-3052 / I
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APR 26 2004 09:14 FR TO 12522470354 P.0.3:1e.3
J�QJACsi RIPAAI,AN PAOPWIf OWNER M47PEpr
I h*roby sertily ehst I Own. propersy adjaaant to
/Ui _ - - �cY 's property
located at
in a F�•��iQ
n n tzs:, N.C.
ry� ncy He hag described to me as indieatad D010W the development
he is proposinq at that location and I nave no oajsotivaa
to his proposal. I understand that a Pig r, pilings and
dredging bust, bo sot bank a minLjmvm distance of Iiftasn Last
115' frob my area of riparian sQcess unless vsived by m*-
I do not wish to naive that sstbauk [gquiV*M*nt,
I do wish to waivr that setback requirement.
LTo be fl1led in by indiv_4dI; proposing devsloPWnt.l
Da�f
f
Phone KuNbet
�1DOP-1Kk C bock }'PWUP•.fo 3DM' Wade War $Lee,` I"aeu or acrtEn,-kwPearj orJN[aS
�OOR�NSS nou�r-�Folen T30+rr yJ.K I o Nap Geoff EYtt`IJD�A ��-o�far�r !-;NcS^
** TOTAL PAGE.10 W*

MAY-03-2004 12:04 P.01
ADjA,CENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
' I hereby certify that I own property adjacent to a,S C is
(Name of Property wner)
property located at _ / ! w �'jL X.54 b
(Lot, Block, Road, etc.)
in G}t1'��� , N.C.
(Waterbody) Rown 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.
1 d-() not wish to waive the setback requirement.
/J I dQ wish to waive that setback requirement.
- ----------------------------------- -----
DESCRIPTION AND/OR DRAWING Of PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
See. 4,�l
ro!�
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-------- --------------- --------------------- I ---------------------- -------------------------------------------
Signature
Print or Type Name
aA 541 — '��
e ephonc Nu�mbber
Date:�7/ 4�
TOTAL P.01

A
Shore.din o st con
"We make your building needs a sure thing with our satisfaction guarantee"
RESIDENTIAL -COMMERCIAL -MARINE
RYAN BAYSDEN
Building Contractor NC License # 53711
[phone]
3704 Oxford Court MHC, NC 28557
shrtng,Yrvahoo.coii t
Mr. & Mrs. Lacy
115 White Ash
PKS NC
PROJECT:
Removal of Existing Dock
New 6'x 20' Pier
New 13,000 lb. Alum. Lift
CAMA

n
rro fed
Pier ��ift
S
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S N
E
Existing
13A��OrO lb.

A.
4 X -'x 0
u;+,n o SI LIC;
Decking
ex
Bolts
211x 8" Cradle
21Ix 611
Bracing
161
� .. I\-- � x ,
21Ix 8" Joi§t
24O.C.
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