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�]CAMA / ❑ DREDGE & FILL '
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 15A NCAC D %N /„ 101)
Rules attached.
Applicant Name �? Or;,V
Address ,5 S`rtj <%.u�r✓
City State `%' ZIP iC /
Phone # (170) s�/O—UA lO Fax # ( )
Authorized Agent
Affected ❑ CW )PW JKPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS: ❑FC:
ORW: yes /;;no' PNA yes / nnoo) Crit. Hab. yes / no
Type of Project/ Activity 10 X 1 b
Pier (dock) I
Platform(s)
Finge
Groi
Bulkl
Basir
Boat
Boat
Beac
Othi
Shor
SAM
Sand
Mon
Phoi
Wain
Project Location: County ;;3V,
Street Address/ State Road/ Lot #(s)'�
Subdivisioni�-
City 1�i ZIP Mks 1 f
Phone # ( ) River Basin
Adj. Wtr. Body - i i dip f (nat/man /unkn)
Closest Maj. Wtr. Body
(Scale:
to v /Ci--
I
�
r pier(s)
i length
dF1
I
L
i
—
i
- -�
i
number
iead/ Riprap length
avg distance offshore
max distance offshore
3
q ,Y / E'
_ --
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-
-
—
_
_
`!
_�
I
,channel
cubic yards
ramP
I
louse/ Boatlift
r
—
i Bulldozing—
r
I
l
I
,
i
.--......
_ —
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t.
aline Length
not sure yes 40� !
nags: not sure yes
itorium: n/a yes no7
0s: yes o
er Attnrherl• vec
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A building permit may be required by: ;R"
Notes/ Special Conditions Gf%'e G'° //' "'• E
Agent or Applicant rrrntea N
//
ra
Signature "Please read compliance statement on of permit"
e / W dr
/back
^I"�°�l r- V 2 �,
Application Fee(s)
/ Check #
;//See note on back regarding River Basin rules.
Permit Officer's Signature f
Issuing Date Expiration Date
Local Planning Jurisdiction Rover Fie 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
Iandowner(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 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 / 1-888ARCOAST
Fax: 919-733-1495
Fax: 252-264-3723
(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
c u r l 9.. e n h a n c e d do n i _ S e h n c k Lo d e f I-[]p•"n"n -- —- =- '
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PRESCOTT BROTHERS INC
141 TARA TRL
ARAPAHOE, NC 28510 1��//66-30/531
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PAY
TO THE
ORDER OF— _ — --
DATE
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FOR
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ADJACENT RIPARIAN PROPERTY OM\rER STA.TENIENT
I hereby certify that I ou,n property 2djzcent to
roperty located at
avll1 <7&4 's
(:\'ame Property Owner)
P -
/� / (Lot, Block, Road, etc.)
on ��,� y� C��.e c,3'� - , in �C Cam' `C �p 9' , N.C.
(Waterbody) (Town and/o County)
He has described to me as shown below, the development he is proposing 2t that location,
and, I have no objections to his proposal.
nESCRIPTION ANrD/OR DRAWING OF PROPOSED DEULOPINIENT,
Nam,
(To filled in by irz,V,idual proposing development)
� � I
S' nature L I�•,,,
T. (Lc�
Print or Type Name
s
Telepho;Ie Number
�- � , � b`� Date: "
—29—
ADJACENT RIPARIAN PROPERTY 011rN'•ER STA.TENiENT -.-
I hereby certify that I own property adjacent to 's
(Name df Property Owner)
propert}' located at ,
(Lot, Block, Road, etc.)
ic' _ , in
on /L
aterb0dy) (To)tin and/ r 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.
DESCRIPTION AN7D/0R DRAWING OF PROPOSED DEVELOPIMENT
(To be f fled iR by indivi ual propos' g development)
D wV%
/J w) Ards►-ou
'6/4 r
Sl�natvZ G ��
Print or Type Name
-2yq - 34q
Telephone Number
Date: 3 - 1 F - D
—29—