31550_GARDNER, JAY_20020327

t CAMA / DREDGE & FILL
GENERAL PERMIT
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
!n A16" Of
Address `f ..7F-
f f l Ccf,;
City. - i t: i' f s t•
At. F _ State �Je ZIP 2�► 5 �
Phone # ( _­(s ) (
9 - C '� 4 & Fax # ( )
Authorized Agent
l� ;
Affected ❑ CW
0 EW El PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)___
Finger pier(s) _
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin. channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length 1 ��(V
SAM not sure yes 'no
Sandbags: not sure yes no
Moratorium: Moratorium: n/a yes no
' vor( Cf
ter / _�7
.R\ O
Previout'permit #
Date previous permit issued_
Rules attached.
Project Location: County _ / C1 t, ,,
Street Address/ State Road/ Lot #(s)
UJR i R 3 /!f; t ► i���t (rr��cJ
Subdivision
31550-e.
City / -I !Ov 1 F111 t r zip- */Z
Phone # ( ) River Basin j 3, le ' ,e
Adj. Wtr. Body r, >, alit - d ko i gnat aii /unkn)
Closest Maj. Wtr. Body— �Oci� -SrvIN k
(Scale: o)cNf: )
�1to(: i j.-.1r;
f �
1 r utt t,h; tr pf4-c ,vv4,� 4 ;
Photos: yes 60
Waiver Attached: yes no
I_
A building permit may be required by: 1! oil 1' ":7r M L See note on back regarding River Basin rules.
Notes/Special Conditions G,tit f)(0j n t !,�� GU-411C 1 c� ��. Ail Jtk't
1 ' 1
-�i.
Agent or Applicant Printed Name
Signature Please read compliance tement on b, of permit
.1 l" i n
Application Fee(s) Check #
Permit Officer's Signature
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, certifythat this 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
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
151-13 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)
Revised 10/C

ERIC B. ELLIS NCDL 65047 2157
JASA M. ELLIS PH [phone]
205 NOTTINGHAM DR. Date—V/1-2 oZ 66-30/531
MOREHEAD CITY, NC 28557
Pay to the
Order of /—/—Z— " i $ ©Or
Dollars 6 2EF.-'- "
FIRST CITIZICNS 133t
B�'K At1a,tic 50na Bank 8 T t Company
l� AUantie Boach, N.C. 28512
':0 5 3 100 3001:00 13 17 4 48 78011� 5 7
OC'Inrkr ArnrNran
UUABUTA SAFEW BLUE ESBL

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT alL''
a 735 ?
er{
o
that I own prp:y adjacent to ,
I hereby certify
s property
n-1 .r.� /���e�_4 �AJSE�gG1 � on
A
located at
AeCEcSG�-'1�-- 1n
(Water Body) (Town ar.d/or County) icates, below the development
He has described to me as ind
he is proposing at that location and 1 have nolobgscandns
to his proposal. I understand that a ,)p
dredging must be set back ariann mum dlunless stance of fifteenwaived by meeet
(15') from my area of rip
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Of pl: r)posed development:
c Desription and/or drawing development.)
(To be filled in by individual proposing
I/JSTgLL-SAT iarJ OF f lEcO (30A'i C-�r r Grii��N 6e
,4 i-c 61 71 �e vulSra/c rdses -d � /� of
r
lre
- �17
Sigi,t.a,ture 1 \
Kol7?l�sek)
Pr Name
Phone. N:,mber

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFI)
I hereby certify 'that I own property adjacent to z A--, is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on 4ff� ir/,a in
(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. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signa e
Print or Type Name
252 - ?.ze, -1z37
Telephone Number
Date: D' DY