51840_DAGENHART, LISA_20071107

❑ CW
Q'EW~
[PTA
Affected
ElOEA
ElHHF
ElIH
AEC(s):
❑ PWS:
❑FC:
ORW:
yes / no
PNA
yes //no
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❑QAMA / ❑ DREDGE & FILL I6 Y �J j9 51 S40
GENERAL PERMIT Previous permit#
El New ❑Modification ❑Complete Reissue ❑Partial ReissuE
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and NatOal esources 1 �) I
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC % ` ! /
l
LJ Rules attached.
Applicant Name -..a
5f--r ( 1 Project Location: County '
Address Street Address/ State Road/ Lot #(s)
City State WI ZIP �% t
Phone # ( ) ( i1 "I" Fax # ( ) �7 Subdivision -
Authorized Agent 'C'( � ? f i J _ 1. t AT City �` '( i( ZIP j ) ,,
Phone # ( ) f River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
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F>r . 5
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
PermitOfficer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # 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 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 (252-946-648 I) or the Wilmington
Regional Office (9 I 0-796-7215) 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.
Raleigh, NC 27604
919-733-2293
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

sent By: AG LEE OIL; 919 934 6013 ; Oct-10-07 iO:39AM; Page 1
} ��
�fn
NCDENR
North Carolina Department of Environment anc Natural Resources
Division of Coastal Managen ent
1&l haei F. Easley, Govemor James H. Gregson, Director William G. Ross Jr., Secrelary
Date � - a ; — a 1?
NO 5 2007
Applicant.Name L- r a Q vl h r
oreh'�d City Mailing Address O. U� OX 3-7 I y `DCM
No, 2757
f all
I certify that I have authorized (agent) ; 17 �-1 ��-�k� i � to act on my
behalf, for the purpose of applying for and obtaining all AMA Permits necessary to
install or construct (activity)��+
at (location) » A4 ladl c, t3 u
This certification is valid thru (date)
Signature �.
400 Commerce kenue, Nlorehead City, North arolina 28557
Phone: [phone]Q81 FAX [phone] Intemet: ww .nccoastaimanagerteni.net
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Pov Consumer Paper

Sert 3y: AC LEE OI_; 919 934 6013 ; Oct-10-07 10:39AM; Page 313
I
ADJACENT' RIPARIAN PROPERTY 0 STXj LrA' Wj*.
(FOR A PIB1 MOORING l'IuNusm0AYu FrBoAmousm
I hereby certify that 1 mn property adjacent to L a �aq znn ar �
propmy immed to _ 4 � �) t3,
l(W, Block, Raid, iic.)
id ? A � I ah � � c
,.
(Waterbody) (fir as
He has dasaribed to #*, u st own below, the dev
location, and, I have no 46jectiou to his propow. I
pilingslbaatliNDaathum must be jot be ft a miniawm &Am
of tiparim t 0cm unim Wdved by ft.'
I * not wish to waive► lia tdbotk squirm
1 ift wish to waive that me;tbock n+quirtmtmt.
DESCRivnON ANDAM DRAWV#G OF PROM
(n beMed in a,► cur pmpasixi t
t
�0 \V
Sr�rtate►re
4 A." 3 Print or T
ZS3 Teicphone
t1w , Date:
se,'LAl
C.
h�nrr)
MC.
vpment ire is proposing ac thal
mdeentand that a pierlmoorint
of nrlm feet (15) from my area
DEVELO V 'n
trrtkr rntt+Kt `"
NOV
5 2007
ty DCAl
{J
Narm
�� '� r7

919 934 6013 ; Oct-10-07 10:39AM; Page 2/3
Sent By: AG LEE OIL;
' ' LUJAt,, AIPAWAN PROPERTY OWNER STATEMENT
(F"OI? A.PIF..RIMOORLYGPI'LINGSIB1OAYL iTIBOATjHOUS -)
l:tcrcLy CCrtily that l owr� iiml�erty adja^cY,nt io t_+SA �QgQ;n_ t s
(Name or 11-operty Owne:•)
(Lot, Block, Road, etc.
r a i
(Water -body)
gown and/or County)
He bas described to me, as shown below, the dcvelopmont he
have no objections Lo his proposal. I under:st<1nd that a pierhnc
must be set back a minirnurn distance of fifteen feet (15') fron
waived by me. (If you wish to waive the Setback, you must
below,)
I do not wish to waive
N,C_
s proposing at th�a localion, and, I
)ring pilings 1 boatlift / boathouse
my tu'ea bf riparian access unless
riitial the appropriate blaa.k.
r/ 1 do wish to waive that setback requirement,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELO. MENT:
g (To be filled in by individual proposing evelopment)
rift
RICE,
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Morehead -
city DCM
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Print or Type Narne
nE9 2 Yos �a6:' - II, E
-3 5 � `\f j Teiephone Number
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