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�CAMA / - DREDGE & FILL
GENERAL PERMIT
j1New ❑Modification —Complete Reissue ❑Partial Reissue
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
Previous permit #
Date previous permit issued_
ED Rules attached.
Applicant Name rx- c &11; Project Location: County
Address / Z l 6t � /Vic/ Street Address/ State Road/ Lot #(s)
City %e7-„ �s 'oru State .w C ZIP 2Y! 7
i
Phone # (l ST 2 V /_ D 919 Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected [ICW MEW (PTA I ES El Phone # ( ) River Basin ,a
❑ OEA ElHHF ❑ IH ❑ UBA El NIA AEC(s): _ Adj. Wtr. Body 1- �- � ' ; �,r i � i (nat )/man /unkn)
-I PWS. JFC.
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: .. .«,_.
Pier (dock) length
Platform(s) 11
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
y s
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other _
Shoreline Length
'a,� �l
I �
----
SAM not sure yes no..,- ,
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: 1
Notes/ Special Conditions
Signature Please reactcompliance statement on back of permit"
Application Fee(s) Check #
XSee note on back regarding River Basin rules.
Permit Officer's/Signature /
�i !l
7
Issuing Date
T% Expiration Date
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 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 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: Fax: 252-264-3723
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: 919-733-1495
(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: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: 910-350-2004
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01
3527
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137 LIVE OAKS RD- NG 28529
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g3/,17/04 ii'EU 21:11 FAX 431.9400 Etheridge Appraisers Z 002
03/17/04 tl'ED 19:50 FAX. 2522490778 Bonnie Lee
MAR-16-2004 TUE 08:50 AM NC DIV OF COASTAL MGMNT FAX NO, 4
U003
F, 02
.C_ERTIRED-M, 1Lt. RE RN REC-E1Y-1MQUESTE..D
DIVISION OF COASTAL MANACFNIRNT
ADJACUNT HTPARIAN PROPERTY OWNER NOT>fRCA'TION6YAWER FORM
Name cif Individu'll•apolying for Permit:
Address of Prop�riy-.—L3 -_..
As bo �.k �� G,._ _ �sL l
(t,�t or Street #; Street or Road, City && Cuunty)
I herL•1,y certify that i own property adjacent to the above referenced proptrty_ The individunI
applyln,° for dfl-s perm`. has de;s ribcci tei'mc as shown Oil the attached dra%vinr the development
they arc proposing. A description or drawirt-, with dimensions, should be provided with this
letter.
1 have no ntjcchons to thiS (rmposal,
If yote lenve objections to li,hal is.. being proposed, plense tvi7:lr flee DiL,isinn of Coastal
tile'd1717t;('77tC'/1[, 1lcsirott 1'lnwW, 151-B, 11)41 '24, Aforehcri�l City, NC, 28557 or toll (2.52.) 808-
2308 i:itleirr, 10 dety,� of receipt of flti.c noliee, No response is consfelererl flee±, sauce cis no objecrion
rf,pnts leave becie rcntifcrl by'Ccriifced Nhiil.
WAIVER SECTIOVI
1 tw-,],�-;tand that a pier, dock, mooring pilings, breakwater, boat house, lift er sindbags must be
sct b,icl_ ri mininntm dirt-rtctr of 15' from my area of riparian access unless %.�-aived by rnc..(lf you
�'�ish to waive the setback, you must inititil the appropriate blank below)
,. ,.._ ...... 1 do wish to waive the IS' setback requirement
1 do 1101 Wish to' waivr thtc 15' setback requirement.
Dile
Print Na-mc
TClr.pt -,nc Number With Area Cude
MAR-16-2004 TUE 08:50 AM NO DIV OF COASTAL MGMNT FAX NO, 4 P. 02
DIVISION OF COASTAL MANAGEMENT
ADJACENT IM"AMAN PROPERTY OWNER NOTIFICATION/WAIVER FORIN-f
Name of Individual applying for Permit: —`—�NNI - �� E-
Address of Property:- /S17 L` Qil� 'K-7-4-1 b -
(t:ot or street k, Street or Road, City K County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applyingo for this permit has described to ale as shown oil the attached drawing the development
they are proposing . A description or drawing, with dimensions, should be provided wish this
letter.
I have no objections to this proposal.
4f you linve objections to ►i,hat is being proposed, please write the Dit,islon of Coastal
iWanc vement, llestrnn Plaw 11, 151-B, 11ivy, 24, Moreliend City, NC.', 28557 or call (252) 808-
2808 within 10 days of receipt of 17tis notice. No response is cousitler-ed the same as no objection
if you bare been ttotifted by Cellifed Mail.
1VAIVER SV,CT10iN
1 urid�!rstand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a rnininlurlr distailc(; of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
l do wish to waive the 15' setback requirement.
I (io not wish to waive the 15' setback- requirement.
SIC lturc Date
Print Name
Telephone. NUrnber With Area Cade