39613_LANE, GHERMON_20040810

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-JCAMA / DREDGE &FILL 'i F
GENERAL PERMIT
Previous permit # A9
-!New -]]Modification -Complete Reissue CPartial 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
F-1 Rules attached.
Applicant Nameh�►�t�'
Address
I �-
City State ZIP
Phone # Fax # ()
Authorized Bent �V r
Affected _ CW EW L-1 PTA ❑ ES ❑ PTS
AEC(s): OEA -! HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
CIRW: yes / no PNA yes / no Crit. Hab. yes / no
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
Type of Project/ Activity
—
(Scale:
Pier (d
Platfor
Finger
I
Groin
Bulkhn
ax distance offshore
Basinrubicyards
Boat r
Boathouse/
Beach Bulldozing MEMMENNIMEM
MOMMOMMEM
Other
Shore LneLength
SAV: not sure yes no
Sandb [gs: not sure yes no --A
MoratMIMMEMENE
Photo!: yes no
Waive a
A building permit may be required by:
Notes/ Special Conditions
MEN
MIN
E
ME
M
MEMOMME
EM1i1MN=q11
0
M
MEMEN..
No
MENOM
IN
MEMMEMENE
MENEM
EMEMEMEMMEMN
EMM
MMENEMMEMEMMUt
MEMEMEMEME
OEM
MOMMEMEM
M
I
MIMIJEU
mmmmmmm
MEMOMMEMEMEMEME
mom
MOMMMOMMOMME
jlc
(
See note
on
back
regarding
River
Basin
rules.
it
.
�
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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
i.
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, certifythat 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 / 1-888ARCOAST
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.nccoastaimanagement.net
Revised 10/05/01

Air. "or Alm. Glwnnon Lane 66-30/531 1726
His ATCDL 1250866 Hers 1904344 -3 154
P.O. Box 207 Ph 527-3675
12775 old Huy 70 DATE
Dever, NC 28526
PAY TO THE
ORDER OF
'4- D01 TARS/2Le
wk for: Micro hpc
laPtST CITIZENS 154 ollwst
F-t-citizons Bank &Ttust company
Kinm-, N.C. 28501
w .firstcItizens.con,
FOR
j:053100300i:001516913206I1' 01726

,J;1L-29-2004 THU 11:03 AM NO DIV OF COASTAL MGMNT
FAX NO, 4 P. 02
ADJACT,NT RIPARTAN PROPERTY OWNER STATEMTNr
(FOR A PIF,RIMOORING l'II INGSIBOATLIFT113OA7IlOUSL)
I lic;rc°by certify that I own property adjacent to G fIL✓OrM 9 &/ L 4
(Name of Property Uwryer)
prolx"rty located at
(Lot, Block, Road, etc.)
( 'ate-1-body) (Town and/or County) 1
He has described to mc., 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/l�ortlifUbc�lihouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless %vaived by me.
I -&-m.o-1 wish to waive the setback rcquircmcnl_
I fl.o wish to waive that setback requirement.
DT.SCRIN ION ANWOR DRAWING OF PROPOSED DLVELOPMENT:
(To be filled in ly individual proposing development)
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Signature ��
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Print or I1 pe Name
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Telephone Numb'eT

'JUL-29-2004 THU 11t03 AM NO DIV OF COASTAL MGMNT FAX NO. 4 P. 02
11
ADJACENT RIPARIAN PROPERTY OWNER STATEM NE
(FOR A PIFRIWOiING I'lLINGSIBOATLIFT/I3OA771OUSL')
I hereby certify that I own property adjacent to n40 W I
(Name of Property Owiler)
property located at _--, G V Off_U)zw'� 1,4 Jle /A1 S o
(Lot, Block, Routi, etc.)
on A` /4I L rA __, in _ .L�/ito/aGD e-m, , N.C.
-- '65'aterbody) (Townand/or d/or County) i
He has &scribed to mc;, 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/hoatliftli,aaihouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless rvaived by ille.
100-viol wish to waive the. setback requirement_ 1.
I ,Jfi wish to waive that sCLback requirement.
T)I SCRCI"I'ION AND/OI< DRAWE"'G OF PROPOSLD MVELOPMENT.-
(To be filled in I)v individual pi-oposi g development)
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}Tint or Type Name
Telephone Nur firer
Date: