50672_TOMS, JEFF_20080409

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 I SA NCAC
❑ Rules attached.
Applicant Name_ ` P L C
Address
City
Phone # ()_
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
rolect ocation: ounty
_f
Street Address/ State Road/ Lot #(s)
_ State ZIP
Fax # ( )
❑ EW -1 PTA ❑ ES ❑ PTS
F-1 HHF ❑ IH ❑ UBA ❑ N/A
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PNA yes i Crit.Hab. yes / no
Subdivision
City ZIP
Phone # ( ) iver Basin i (! ('
Adj. Wtr. Body na a unkn
Closest Maj. Wtr. Body
•
M.
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Agent or Applicant Printed Name
Signature -* Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
j
issuing Dat6 r ( Expiration Date
l l
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, 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 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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)
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 08/09/06

4r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to.1
(Name of roAWw F-4
property located at /C� J f MAR ®ZOOS
(Lot, Block, Road, etc.) / /�' Morehead City DCM
c4 on / (E. �f r jr 4 in ��D/f !mil ,e i' , 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. I understand that a pier/mooring pilings/boatlif /boathouse
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)
r_ex�1,0ve? doe__
�i �•_v_ � _ ` �dr�.� 6� � ���� _ _e c� � � /:rT rem ,
5r� r¢r°e,*
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/-----------------
1 (Applicant Information)
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MailingAddress 1 k !�-1
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City/State/Zip
`71 1 - Ifs
Telephone Number
3 J -7
Date
W X / Q,,�--, PAiAl-
iparian Property ner Information)
0 .
Signature
\� ZD vas 6, v6' o
Print or Type Name
s�_ -744-1/2,,e
Telephone Number
?),),P;
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to i %'G / ©0 !
(Name of roperty Ow r a
property located at �� �� �.,G,� � � YAR
a
(Lot, Block, Road, etc.) 0reh aw ,
on Ile. � r` � /� c � � , in ����'� � 1 ,- fl/ (— / �' c' , 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. I understand that a pier/mooring pilings/boatlift/boathouse
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.
LI do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
a
7,;14 7rl
(Applicant Informaation)
Mailing Address
110 velock , /\/C
City/State/Zip
--------------------------------------------------------
(Ri rian Proper O er Information)
sign a rep (� Jl /
TYl l7 •
Print or Type Name
Telephone Number Telephone Number
Date Date

241
JEFF TOMS 66-211530
NCDL 46140 Ph 252-726-7514 . 4 BnA H 77614
1609 Shepard St ate
Morehead City, NC 28557 $ l/`r ^O
Pay to the
Order of _ Do lays
WACHOvra
+� W chovia Bank, N.A.
For
02L9ti:L054�32?SS01
i:05300i�' 4L