51539_COLLINS, KATHLEEN_20071030

❑ CAMA / ❑ DREDGE & FILL
Gperm GENERAL PERMIT Previous it #
❑New ❑Modification El 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
❑ Rules attached.
Applicant Name , '- e s. ,'i t .
Address
City
State ZIP, `3
Phone # O
Fax # (� )
Authorized Agente—
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
ElHHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: /0� )
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) i [ i 1
Beach Bulldozing
Other
e
I
I
I
s` I
Shoreline Length LSIi
SAV: not sure yes L
Sandbags: not sure yes /i�o —
Moratorium: n/a yes
Photos: yes ra0' _ - -
Waiver Attached: yes n�
A building permit may be required by: �1 r •t ,c �,' �] See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
mitOfficer's Signature
y•
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name

ft
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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
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)
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIRRIMOORNG PH.JWGS1B0A7UFT1B0AT/H' OUSE)
I hereby cer* that I own property adjacent to`�� LC �w�
(Name of Property Owner)
property looted at (2 qJ—VA -t_YL( —,Z)—P=_ ,W / M
(Lot, Block, Road, etc.)
on I 2�1��l�,fi" l � e fr in e T Y N.C.
(Waterbo ft) awn altwor 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 / boatliii / boathouse
must be set back a minimum distance of fifteen fleet (IS) from my area ofriparian access unless
waived by me. (If you wish to waive the setback, your mint initial the appropriate blank
below.)
I do not wish do waive
I do wish to waive that setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fl&d its by htd dprgposing *vdo t)
�,� c.�11 "► �� �� ns on
�A�
Signature
rr1, 7-
Print or Type Name
Telephone Number
Date:

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERWOORINGPILINGSBOATLIFTBOATHiiOUSE)
I hereby certify that I own property adjacent toyA 1 �-I L UI I K� "s 's
(Nance of Property Owner)
property located at _QL UOS off/ 1ct Q C /2 Q ��- • �,1�� ,q�J
(Lot, Block, Road, etc.)
in
on �/ �`'"�-� I �( l� .Gr N.C.
n
(Waterbody) ownadd/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 / boadift / boathouse
must be sex back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
beWv )
I do not wish to waive
I do wish to waive that setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by w&vidW proposing development)
2J2 Shwliru!)P.
brae �� I ► �� ,� `� ns °'�
Signature
Print or Type Name
Telephone Number
Date: Q f 2—L Z-�<3y 7

T
J�A--e-4
, 6
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F, Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
t �
Date
Applicant Name
Mailing Address 10gq
O3 2Z-('0
I certify that I have authorized (agent) �H �C-e-5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification is valid thru (date
Signature
r l
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.riet
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