37561_LONG, JOHN_20040304

7
7
GCAMA ElDREDGE & FILL 7-
IV' -
3
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
0 Rules attached.
Applicant Name { Project Location: County
Address
City t t ' " i State ' ` ZIP
Phone # ( ) Fax # ( )
Authorized Agent
❑ Cw ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
i /-4''d1,, ", .c
Subdivision
City f ZIP
Phone # ( ) River Basin
Adj. Wtr. Body 00 my,1 tokc i (nat / ia—A /unkn)
Closest Maj. Wtr. Body � • , S '
Type of Project/ Activity
(Scale: ,v " r )
Pier (dock) length
Platform(s)
Finger
Basin
Boat
Beac
Othe
Shor
SAY:
Sand
Phot
Waiver Attached: yes no.
A building permit may be required by:
Notes/ Special Conditions
on back regarding River Basin rules.
S
!�� j .o' Alt
❑ See note
a
( 0 f•
�y r
I
pier(s)
Agent or Applicant Printed Name
Permit Officer's Signature
Signature a Please read compliance statement on back of permit
Application Fee(s) Check #
r
Issuing Date 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
El 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.nccoastalmanagement.net
Revised 10/05/01

2630
ERIC B. ELLIS NCDL 65047
JASA M. ELLIS PH [phone] 66-30/531
205 NOTTINGHAM DR. Date 133
MOREHEAD CITY, NC 28557
Pay to the
Order of p o
4— Dollars
FIRST OTIZGNS-
., K Fern -Cc Be Bank 2 tComPany �Y
1'�Yq"Iy AIIanUc Beach, N C. 2B512
www.firstcitizens.com M,
Fol6a 3-75-61 iIti (Z. L��2
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FROM TYNDALL'S - HANES MALL FAX NO. : 336-659-7995 Feb. 09 2004 09:47PM P3
ADJACF- "4 ARl.A,,N PROPERTY OWNER STATI"MEN7
(FOR A PIERIA400RING Pit INGS/,BOATLIMBOATHOL'SE)
I hereby certify that I Own property adjacent to „ "— I
(Name or Prapertti• Owne~
grope,, y =Ltd at
(Lot, Block,
oad, etc.)
on ._i
(Water ody} (Town and/or County)
He h25 cues rbed to me, as v'-own below, the development he is propos: 7- ar that location:,
and, I have no objections to his proposal. I unders id &z pier/ moor:.-1?
pii hp"boadirfboa;house must be se: back a minimum distance of fifteen fee_ (15') Fom my air-
Of rt'Iar] access wilm waived by me.
- -- � I dri not wish to the setback requirement.
I d• wish to waive c .at setback re_uiremelc.
DESCRIPTION ANVOR DRAWPiGr OF PROPOSED DEYELO? M,-,T: -----
(70 be Aced in by individual proposing development)
16, x 1 3',C/;
.S•—?nature
.� 41, o fe Es ,q 0
Pint or Type Name
1se?' ? V 7 -
Telephone �3�11�C;' --�

FROM TYNDALL'S - HANES MALL FAX NO. : 336-659-7995 Few 4 09:46PM P2
A.DJ1tCEtiT RTPARL-,j_'V PROPERTY OW] -ER STATNEEN-T
(FOR A P'ERIMOORING PILINGS/BOATZIF7780AThtOC•SE)
I. hereby cer dfy that Y own property adjacent to
(Name of Property O. er)
Proper, located at
(Lot? Block,
d, etc.)
on C� 1�✓,+t 1 , in P�rs LisLg� SeF2r 5 , N-C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development a is praposi � a:
h - that iocatio-I,
and, I have no objections to his proposal_ I anee:swid th=.., a pier/ moorn�
pilL<<sr"boatiil*lboathouse must be se: back a minimum distance of fifLac;i fe_; (.�') tom my a.�ea
Of rp&an acc: S5 unless waivers by me.
'--� I do not wish to wa.'VC the setback requiremeac.
s% wish tO wa�,ve t; at setbac recuirement.
DESCRIPTION A-SDIOR DRAWLN. 'G OF PROPOSED DEVELOP.NIE.',T;��___�
(TO be filled in by individual proposing deva?op?nenc)
G✓ /6
rPro 00
------- -----------.��_�_..
Signature
NE J
Print or Type Name
Y�-s2Z
Telephene Nu1rber