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CAMA / ❑DREDGE &FILL � p
GENERAL PERMIT Previous permit
❑New ❑Modification ❑Complete Reissue ❑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
Applicant Name
Address
City Stater ZIP r
Phone # (qP)1 t� `j Li ""Nk 5 Fax # ( )
Authorized Agent
Affected ElCW Sf] W E'PTA `❑'ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
s-,
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County ( "_ r-'. ; � - ,�.
Street Address/ State Road/ Lot #(s)
� r
Subdivision _
City r 1, ,i ZIP
Phone # River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing DatJ I Expiration Date
c>
Local Planning,lurisdiction 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 consistentwith 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)
www.nccoastalmanagement.net
Revised 10/05/01

BROOKS DREDGING & MARINE CONSTRUCTION INC
507 BAYVIEW DR PH. 252-728-6886
HARKERS ISLAND, NC 28531
PAY
TO THE
ORDER OF
orehead City NC 28557
FOR I
11'00150Bn' ':0531124661.
000
1508
66-1246/531
DATE --O
$ 166 , iro
_DOLLARS
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APR-29-04 SUN 08:58 AM COBB EZEKIEL BROWN & 00 FAX NO. 3362228718 P,02/02
firK-�y-Mq CHU 08:43 AM NO DIV OF OWTAL MGMNT FAX NO, 4 P, 02
ADJACENT 'UPARTANPROPERTY OWNER STA'T'IEMENT
I hereby certify thz, r own properly adjacent to 306/`/ PA
(NAme of PrO�ctty wrlt=r) —""'
t7roit�rty JvcatEtl at _�/a /��' ,.
(Call i'IOcl(, Rold, cic_)
Oil
Zic,•bad��) ----` N.C.
(1'oxvrn andlor Cottmy)
Ike has dcsclibed to me as showy b0igW, the devetoptnen; he i5 proposing at that location
+itri I have; no olajcctions to his proposal.
2i� SCitll'i'iC)arI AND/UR URA1t NC OT' PROPOSED DF: V L FI11 N-r ^.
(7b fie fled in by"liviLirt01propo.s1119development)
Signature `-----
Pnnt or Type Name
Tr1c��hone Nunibct
Date: , ! z I l0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I �
I hereby certify that I own property adjacent to 's
(Name of PropertyOwner)
property located at / ( /D #48"5 .1 5 -Pd i
,/ (Lot, Block, Road, etc.)
on iA�G/t `� , In � Rke-As ��, �` , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIMENT
(To be filled in by individual proposing development)
Tm000lo a
Signature
I PAC,
Print or Type)Name
Telephone Number
Date: S - 1- e c