30547_JAMERSON, WALLACE_20020304

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue El 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
kC� cct
Gl < y:W
Address %•
11 1
t^i! t Y j 1 1�"�
City
State '\k- ZIP,. ' i- r
Phone #(-Y "
Fax #( )
Authorized Agent
Affected -ICW
❑ EW
❑ PTA ❑ ES ❑ PTS
AEC(s): LI OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWs:
❑ FC:
ORW: yes / no
PNA
yes / no Crit. Hab. yes / nc
Previous permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
❑ Rules attached.
ZIP_
Phone # ( ) River Basin
Adj. Wtr. Body r (nat lman /unkn)
Closest Maj. Wtr. Body
City
Type of Project/ Activity
J
n,,,'.t . 1,,, ! �: y K ��' a �' / c. r � l (Scale: �lc r-� )
C Csnc' 1. -��('a a
Pier (dock) length
Platform(s) ; -_i _ _� - ❑ - f I
Finger pier(s) Y N �) C❑tom rL i
a i-�G-.
I('
Groin length
--I I- _.__ � - ;.. i ----
number
- --
Bulkhead/ fLprap length
}
avg distance offshore
� _ I
1-71max distance offshore
-
Basin, channel -
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes
no
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
r�
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration 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, 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 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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 10/05/01

OorL Oawzal�
.S1/� .�u5ritaur
� �stierrtaL ✓�' �,S7f
s Pay to the
w Order O
1028
66-152/531 CLS
Date
WOM
WS boy18 Bank ?$A.
Bayll=, NC 28515
Foe1191�EL4,.,�
1:0531015291: 0787 21396SO 1028

ADJACENT RE'ARIAN PROPERTY OWNER STATMENT
(FOR A PIER/AIOORING PILINGS/BOATLIFIYBOATHOUSE)
I hereby certify that I own propert adjacent 1
Y � cent t• �.1 q P � w,,, ,-- � is
(1\'arne of Property Owner)
Property located at //a ? � /'/ Al // - /
n (Lot, Block, Road, etc.)
on I �bi� r� 1 " t -o P -k
(Waterbody )
— + in, N.C.
(Towzz 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. I understand that a pier/mooring
pilings/boatliftlboathouse must beset back a minimum distance of fifteen feet (I5') from my area
Of riparian access unless waived by me.
y/ I dO not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
-- --------
1RrION AINDIOR DRAWL\;G OF PROPOSED DE'L'ELOP�iE;�'T:---------
DESCR
(To be filled in by indiliduol prooposing de►elapmen!)
��4 6! Shaded o�rea- is old
�1e-r
-------- --------------------------------------------------------------- r--L.. L --i- -- -
SignatuSg
Print or Type Name
Telephone Number
Date.
1'd bTLE-6bZ[ZSZI auipuax0 uoQ e01:60 20 ge qa-�

/f
AWACENT RjrAA Ax rRQMT V O%VNER sr�
(FOR A P/£R/AJOORINC plUN!T"Or17L1P1/Z;ttJAATI{QUS
f txtrlfp lAxt't OrNi propeny *Qaow io
0.rv� c---�_ �i
(time of ls+*+pert�.Ow ncr)
Property locaiedat
{ r u.aa act, iCaad,a(e� '—
m..i
f►lstcrbudyl (Tors twd/oe County)
Ho Aas faS4(bed 'so me, as do" below, tk dvIdopmeot be is proposing a( Thin
kxxtiai, snd, T Aawc ho at*tians fo his trcpotaL f undcnt Ad that tr pin-ltnuorirra
yitinyslbpadiltAboathou- must be sd barks a dlstance offlfb= fmt (15) rratn my arcs of rlparisn treat unku waived by mc.
X l -4h so wwve the lubadr togaxrrutsrt.
1 99 .M iYh ro waive " aabaek tegairt:rwm
D><SCRUMON AMOR DRAT ING DF MOpQ=
(To Drffllyd le iy buklid"aNwaRf embpmter)
lice,
sae
I
:el�,!'� SKA.6ed 'a.rett,is of l
T_ c,P L 0 � (0
runt. or ,y,e Nww —
_3_0l -logs-1679
Tckphow Nymbd _
ou-- _.2 - z k- Z a o 2_