39669_STATUTO, RON_20040916

�CAMA / ❑ DREDGE & FILL �
GENERAL PERMIT
Previous permit # %
DNew '-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
�) rules attached.
i
Applicant Namefl Project Location: County ^�
Address �'" `� J I l Street Address/ State Road/ Lot #(s)
���� State ZIP 03 ` �gl l 1 (t i ✓e t J 1
City
Phone # (B�3) Sly Fax# OSubdivision
Authorized Agent P
tY ,
❑ Cw 1-EW 0-PTA ❑ ES ❑ PTS Phone # O River Basin
Affected
HF El IH D UBA El N/A
�� ff f!
AEC(s): Adj. Wtr. Body CT' / at man unkn
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity CA
�I P ! • �f
Y Scale•
Pier (dock) length
��' x 30' i
Platform(s) �-
Finger pier(s) j
Groin length -- ---- -- l
--- ___
number �'- _._—_ �-—_.----,— I------- -'---------------- � 3
Bulkhead/ Riprap length
avg distance offshore
max distance offshore -
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other o c
•
t � Y
Y rr
-- - JLVL
rG,
;?
`I yJ
rqq'
i \
I
Shoreline Length ' V r r I _
SAV: not sure yes no
Sandbags: no sure yes ® • ♦ /
Moratorium: n/a yes O J 46
Photos: yes
Waiver Attached: yes hgS Q
A building permit may be required by:
Notes/ Special Conditions 6,0jA �� }�•
1/1, "'( f/ 87 V" ,-�-- L. Jy q n f
Agent or Applicant Printed Name'
l
Signature Please read compliance statement on back of er�ni q
g P p :T* **
�uO.JJ
[9-fee note on back regarding River Basin rules.
rermit u"icews signature
q- M-0 V /�- 06-O Y
Issuing
/nDate Expiration Date
6
Application Fee(s) Check #
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:
❑ Tar Pamlico River Basin Buffer Rules El Other:
euse 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 CiV 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

PRESCOTT BROTHERS INC
141 TARA TRL
GRANTSBORO, NC 28529
PAY
TO THE
ORDER OF���
H PST CITIZENS 472
[� A ATV FirsbCitizens Bank 6 Tmsl Company
�)A � A Oriental, N.C. 28571
.fi�nM
�CA!
FOR �^`7�
11000 2699ii' i:0 S 3 L00 3001:004
DATE
L C-) ,-
7/ 0 2S4 29ii'
2699
66-30/531
472
DOLLARS 1 °

ADJACENT RIPARIAN PROPERTY Off' N'ER STATEMENT
I hereby certify that I own property adjacent to
(Fame of Property Owner)
property' located at
(Lot, Block, Road, etc.)
onin
(Waterbody) (Town and/or unty)
S
1 Cep , N.C.
He has described to me as shotitin below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION A.?\TD/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
-29-

ADJACENT RIPARIAN PROPERTY OWNTER STATEMENT
certif • that I own property adjacent to I - -
I hereby } r ! y .1
(Name of Property Owner)
i —A0— S/ 7 --d C 7,9
property located at i V L S ��
(Lot, Block, Road, etc.)
on 0� 4R�_ ! in PXU Gd '
(Waterbody) (Town and or County)
N.C.
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 AND/OR DRAWING OF PROPOSED DEVELOPiMENT
Print or Type Name
'.� ply- 9r6 0
Telephone Number
Date:
MWJM