32875_ADKINS, T F_20021018

CAMA / El DREDGE & FILL -�V 32FMrC
GENERAL PERMIT Previ us p
LIermit#
New ElModification E Complete Reissue L-]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
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Applicant Name i4eivil,
Address
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City State ZIP
Phone # Fax #
Authorized Agent
Affected El CW �EW � PTA E:1 ES El PTS
AEC(s): El OEA 0 HHF 0 11H El UBA 0 N/A
El PWS: 0 FQ
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County CJ-�
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone# River Basin LU
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Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit e S' ature
Issuing Dot
'Expitation Date
Local Planningjurisdiction
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer RulesJ Other:
n 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
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 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

THERESA A. WILLOUGHBY NCDL 18s91ss
SHERRILL W. WILLOUGHBY NCDL 1343489 3974
212 PRESCOTT DR PH 919-541-5645
DURHAM, NC 27712 66 763/531 CC
Dale
Pay To The n `
Order Of
WACH�VIA Dollars
Wachovia Bank, N.A.
Durham, NC 27701-3228
1:0531076331: 237i 50452Bn' 3974'
O NAf1�AND ZODp

ADJACENT RDP'ARL�N PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOA TLIFTIBOA THOUSE)
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I hereby certify that I own property adjacent to !vS Is
(Name o Property Owner)
prope.7 located at / % L Az ,
(Lot, Block, Road, etc.)
on /►' i , in C�- Z, ice/^ e , N.C.
(W terbody) (Town and/or County)
He has descroed to me, as shlown below, the deve'.opment he is proposi-= a. L' at location,
and, I have no objections to his proposal. I unders=d that a pier/mooring
pdnas;bca`liftlboathouse must be se, back a minimum dis=ce of fi,Eetn fee: (if') from my area
of tipa:-ian access unless waived by me.
I do no wish to wai�'e �' ` -0 2 7 2002
the setback requir, meat. d
_ I jL wish to waive t.at setback rec uireme:it.
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