40021_VALENTE, PAM_20041005

i-1C~A / __ DREDGE & PILL
WGENERAL PERMIT
E'New [ 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
Applicant Name
Address C
b C-A 6, i r/
City
Aef'° StatePv C. ZIP"
Phone # (.r� )�
6 x'6 a
Fax #
Authorized Agent
I
L-� ` ' Y /- '-
Affected L CW
EBB C9-PTA ❑ ES ❑ PTS
AEC(s): ElOEA
❑ HHF ❑ IH ElUBA ElN/A
PWS:
C FC:
ORW: yes / no.
PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)_ 1
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
x
max distance offshore
Basin, channel -'
cubic yards
Boat ramp
Boathouse/ Boatlift, /
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes r�
Sandbags: not sure yes no
Moratorium: n/a yes n
Photos: yes no
Waiver Attached: yes n --
A building permit may be required by:
Notes/ Special Conditions
id'rl
'Previous permit #
Date previous permit issued_
Rules attached.
0
Project Location: County__ _
Street Address/ State Road/ Lot #(s)
Subdivision J� a V'`
City' ` t"'� ZIP
Phone # ( ) River Basin Ale
Adj. Wtr. Body l (na a' /unkn)
Closest Maj. Wtr. Body
n , (Scale: k , )
i -
Agent or'Applicant Printed Name 4 J
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
, v
Local Planning Jurisdiction Rover File Name

t Y
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 consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
,Tame�r - Pamlico River Basin Buffer Rules F 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 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: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead Citv 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 10/05/01

� POST/3L SERVICES pos'u , 1Vit-rN Y uu"- u 000
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U.S. DOLLARS AND CENTS
0 7 3 5 A 3 2 8 0 3 3 2004.1 O-01 285570M=2`a
ONE 44UNDRED DOLLARS & 004
AMOUNT. ..
NEGOTIABLE ONLY IN THE U.S. AND POSSESSIONS
PAY TO
SEE REVERSE WARNING
CLERK
ADDRESS
FROM
0
ADDRESS
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C.O.D. NO. OR
-
USED FOR )1 l „V
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1:00000800 `� \'`' 0 7 3 58 12130 3 All,

ADJ:4.c:ENT RIPARIA.l'°d PROPERTY
(FOR A PIE RIMOORING PILI.'VGSIBO,4TLIFT B AI N USE),
hereby certify that 1 own property adjacent to(narote of prpper"ty pwmer) r
ptopeMy ideated at
(Lot, Rio , Road, etc.) !�
._.. _ in ..._—_- t d . �C .
on 4—"Ilamoor County)
�� �er ody)lac h
,d to me, as shmwn tu.iaw, the development he is proposing at that ocation ,
and,
i have no abje�tians to his proposal i unc�erstand that a p S
giiirtgs1toat!iftlboathocarre must be set hack a minimumr distance of fifteer, feet 05') from, ,may area
.f riparian access tinless waivers by r^e.
i wish to waive the setback requ;rernent.
i do wish to waive that setback requirement.
- --- -----------------------------.-------------------.....------------- ------------------
DUSCRiP'l ION AND/OR �hpR NV �G O pro p SE[)cpEVEL-OPr`IF:�v't:
(To be filled J Jg
/ /
0
E3�A�'
------- ------- -- -- - - _. -- -
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S►gnat� e -
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Print or Type Name
2-- 2 Z
i elephone Nurnher
Date: wJ

ADJACENT RIPARIAN PROPERTY OWNER S'TA'TNYM
(FOR A PIERIMO(,iRMG pit, #brs1B().ATLIFTIBOATH � F)
I hereby certify that I own ;property adjac'.rit to(� �e of PeaPerty Owner)
prope�y 1s�catrd at
�GoA, R1a , Ro:ed, etc.)
on (To.vrti an for County)
CVi ate ody)
to me, as shown below, the develap:'nent he is proposing at
lie has his pioposat, 1 understand that a pier/mooring
and, I have no ejections to
P
ilirtgslboatiiftlt�oathcwse mtist be �t back a s�tiinimum distance. of fifteen feet �t5') from my area
of riparian access unless waived by ,tee.
1 wish to waive the setback teqWrerne��t.
I dg wish to waive that setback require,ne'tt
-_..--------------------------------------------..------- --- --------------
DESGRIPTION AND/OR DRAWING OF P Q APO ED DEVELOPMENT,
(To be filled in by individual proposing
I-
---------�
A
Si 'u
Print or Type Name
'1"ele�hane Number
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