43603_DEREK, SMITH_20051130

J,CAMA / DREDGE &FILL
GENERAL PERMIT
L'New _JModification L]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
�®a
�C
Previous permit #
Date previous permit issue
C ❑ Rules attached.
Applicant Name ' '' J Project Location: County
Address 00
C
City %�?? ` ` ` '� ' "� StateX) l ZIP S '
Phone # (__ ) `' 7 �6 Fax # O
Authorized Agent / 'G' pl(.(,.-
Affected ❑ CW C?M LR'PTA [zES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
-i PWS: ❑FC:
ORW: yes / no PNA yes /`..oi Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length—L—�-��
avg distance offshore ` _%
max distance offshore j
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other _
Shoreline Length
SAV: not sure yes 6;1
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes 'no
Waiver Attached: yes,' no
A building permit may be required by:
Notes/ Special Conditions
f-4:krCfC-C._.
Agent or Applicant Printed Name
Signature * Please read compliance statement on back of permit
Application Fee(s) Check #
r' I
Street Address/ State Road/ Lot #(s)
Subdivision
J. t X
City ;`xr, �, j ZIP
Phone # ( ) River Basin
f i
Adj. Wtr. Body �' `��-1 V i J (nat /maN /unkn)
Closest Maj. Wtr. Body
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
a
Issuing Date
Expiration Date
1 13`' 1.rA
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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar -Pamlico River Basin Buffer Rules
❑ Neuse River Basin Buffer Rules
❑ Other:
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 (910-796-7215) for more information on how to comply with these buffer 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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

Adjacent Riparian Property Owner Statement
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Ditf e- k , 5 jm; +4 N is
Name of Pro erty Owner
property located at g S A6^ Law ` ,
Lot, block, road,, etc.
on WSJ Qter, in L.Ariel��— , NC
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.
I do_ not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be filled in by the individual proposing development)
Signature �• �• � J�{
Print or type name
-- LaTs'`7
Telephone number
Date

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d""jacrot Ripurian Property,
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L,."' PeA
INC
He degzibed to me, as shown below, thr c7e-v CIOVWidg, 1111 4S SWQPO$* 4S,
M objtalcaaxs to him prow.
V i kWA Vvish to WUXN'a; the settWs:lc r'-,L4='Yien+t.
(To be tMed ki by the hadzvkAvJ priming devvIopment)
P
Mai or type mane
Telephone number
Fred Fy'n
/"4it/ <z =P a /*L�e J'4

U. F. S., LLC
101 DOLPHIN WAY
BEAUFORT, NC 28516
252-72B-7576
PAY Memo:
TO THE One Hundred and 00/100 Dollars
ORDER
OF:
CAMA
"100285611' 1:05310IS291:
WACHOVIA BANK, N.A. 66-152/531
MOREHEAD CITY, NC 28557
546 L 00544 LII'
AMOUNT
2856
DATE
Nov 4, 2005
*****$100.00