39376_LELLI, THOMAS_20040811

-� ❑CAMA / ❑ DREDGE & FILL I
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 I SA NCAC
❑Rules attached.
Applicant Name "0 a f 'Cr Project Location: County
Address `� ��y ,n • X Street Address/ State_ Road/ Lot #(s)
✓`'" State ZIP
City f ZZ
Phone # () 6 '? Fax # O Subdivision_. _
Authorized Agent City ZIP
Affected J CW ❑ EW [S•PTA ❑ ES ElPTS Phone # (_ ) River Basin J '
AEC(s): v OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
PWS: ❑FC:
ORW: yes / no PNA yes / no j Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s) _
Finger pier(s)_ _
Groin length _
number
Bulkhead/ Riprap length __
avg distance offshore _
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatlift I
Beach Bulldozing
Other
Shoreline Length
$AM not sure yes no
Sandbags: not sure yes no.
Moratorium: n/a yes no I
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
(Scale: )
L
Fq"See note on back regarding River Basin rules.
Agent or
_Afyptfcant-Pn ted Na
Permit Officer's Signature
�\C✓'
f
Signature ** Please read compliAnce stateir
Application Fee(s)
of permit Issuing Date
Check # Local Planningf urisdiction
Expiration Date
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
pr$nces, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
la�dpvvner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis 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 IO/bS/bl

THOMAS J. LELLI
LINDA A. LELLI
5008 PLYMOUTH CT
Bank of America Advantage
2309
66-19/530 NC
3100
NEW `BEERN, NC 28560 Date 1 2«
Pay !� R U $ �GG.CO
to the order of Ano
BankofAmeric a�'
ACH R/T 053000196
Memo e R71VI, / v,roec. 0.-_
i:05300019D: 000313261596110 2309

ADJ� ENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILING/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent
(Name nrprnperty owner)
Property lacated at.57Q6� o� __—
(Lot, Rtnck; oad. ect )
N.C: �(
�2-G3G-36132
(W al er hndy) (Town mid/or County)
He has decrided 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 piling/boatlift/boathouse
must be set back minimum distance of fiReen feet (15) from my area of riparian access unless
waived by me.
_y/,'*'— I do not wish to waive yhe 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
Print or ype Name
ZJ
Telephone Number
Date
/VOK w�zJl— C/�lG
��o W
Foley & Foley Contractors

ADJECENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILING/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent Is
(Name (Name of property nwner)
Property lacated at Q6ef uv % CT
(Lot, Block. Iiin,d, ect )
on/JZD�-- a E (?4 lc, in N.C.
(\V�lothndy) flown and/nr Cminty)
He has decrided to me, as shown below, the development lie is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring piling/boatlift/boathouse
must be set back minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
do. not wish to waive yhe setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
( To be tilled in by individual proposing development)
c
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Print or Type Name
Telephone Numbcr
Date
Foley & Foley Contractors