40092_WELCH, CLARENCE_20041101

7CAMA / f-1 DREDGE & FILL 'S
GENERAL PERMIT Previous permit #
JNew CModification ❑Complete Reissue l_JPartial 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.
Applicant Name C��%T P �11' 4-u �C `1 Project Location: County 6
Address l ;S G 3 {_ Q/CQ /Dr , Street Address/ State Road/ Lot #(s) c G d/
City p t State VC ZIP
Phone # (� �) % )G - /�%, Fax # ( ) Subdivision - 7
Authorized Agent City V2 1 a4 r e<<EC11-d (' Al ZIP
DEWDEWPTA ❑ ES ElPTS Phone # ( ) i � ' 1, yS"�. River Basin �-�� ' lis�
Affected r ; OEA ❑ HHF ❑ IH ElUBA El N/A �;
AEC(s): Adj. Wtr. Body ; �� c G k (�%man /unkn)
0- PWS: El FC: / •-
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body Al
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length !�
avg distance offshore j
max distance offshore
Basin, channel ? r
cubic yards
Boat ramp /
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
!
SAM not sure yes—
�w
Sandbags: not sure yes-'
r
Moratorium: n/a yes Cn
1/ ��.
Photos: yes
"
Waiver Attached: yes Ln"
�iQ-'�7)�'C
A building permit may be required by:
/ '
❑ See note on back regarding River Basin rules.
Notes/Special Conditions
Ile
` .0 4'' y Ic: u,
/%
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
' I /' / - if �/ ) - /- Q.5kl
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name

4
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 �_ _� 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: [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

v
CLARENCE H. WELCH III
BEATRICE I. WELCH
1803 CALICO DR. PH. 726-4657
MOREHEAD CITY, NC 28557
PAY TO THE Al C—
ORDER OF
66-85/531
0280061835
DATE I� I
5725
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to IV cz
(Name of Property Owner)
property located at / S� 6 C: o /i Co 0 ,
(Lot, Block, Road, etc.)
on L'c -e- , in Flo tie y , N.C.
(Waterbody) (Town and/or 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 AND/OR DRA«'I`'G OF PROPOSED DEVELOPNIENT
(To be filled in by individual proposing developm
1'
1
L
NOV 0 1 2004
Morehead Giy Dc,�,4
\�
-------------------------------------------- -- '--------
I---------------
0'� -La —k-) i //Ii
Signature
L (Wb,A l � P-)&6) 5,117�1
Print or Type Name
Telephone Number�c�
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -,- f, (;J� (c 4�' ` 's
(Name of Property Owner)
property located at /ga er, /,, c u mow. ,
(Lot, Block, Road, etc.)
on (2G,/r�•a <Dv,r— in ye,o�acrl C/ , N.C.
(Waterbody) (Town and/or Count f)
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 DRAWL-NG OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
,LUv
()o K Q (3U
NOV 0 1 2004
Moreh -cad City DCM
1�
-----
Signature
'WWe%/5 P 0,Z' i4 j1
Print or Type Name
Telephone Number
Date: �� %5� �7C�