51587_FUNA, DAVID_20071022

❑ CAMA / ❑ DREDGE & FILL Ew 5 1 5 8 7( 'I
6�GENERAL PERMIT
Previous permit #
DNew' ❑Modification ❑Complete Reissue
❑Partial Reissue Date previous permit issued
As authol.zed 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
EJ Rules attached.
Applicant Name '. /` i ., t
Project Location: County
Address OL `.r 4 C t +
Street Address/ State Road/ Lot #(s)
City State _ ZIP
4
Phone # O - '� fax # O
Subdivision
i
Authorized Agent
City t ! _ `T`�t ZIP
ElCW ❑ EW ❑ PTA El ES [-IPTS
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Phone # ( ) _ I '? -1 I i River Basin
Affected
AEC(s): EloEA ❑ HHF ❑ IH ❑ UBA El N/A
Adj. Wtr. Body gnat /man /unkn)
El PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab.
yes / no Closest Maj. Wtr. Body
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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
Issuing Date Expiration Date
Local Planning) urisdiction 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 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

i
'A*A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director Willia G. Ross Jr., Secretary
Date 6 - - 0 CS1
OCT 1 1001
Mo feheaa. _
Applicant. Name a.� ; � �� A N � ltY ®cM
Mailing Address C-7
•• New�oc�' � C. �-�S7 O
I certify that I have authorized (agent) -RQ$6115 w to act on my
behalf, for the purpose of applying for and obtaining all CANIA Permits necessary to
install or construct (activity) \C�j LU
at (location) Lo+ .a �� � � Y AxV— ; 1y oC L r' d` OT P C. .
This certification is valid t u (date) 3 dg
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

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Oct 02 07 01:53p Coastal Equipment Rental 2527260340
P•2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERWOO,RING PILI1VGS/BOATLIFT/B0.4 TI10USE)
I herby certify that I o::a property adjacent P.o
property located at Lo#
(tiarae of Property
(Lot, Block, Road,
`s
�
on C� e�i�ry� SoVrJ in 1l �=k4Z' 1 C.-Ac..,T , N.C. vv�
(Waterbody) (Town and* 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 i boatlift l boathouse
must be set 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 roust initial the appropriate blank
below.)
I do not wish to waive
►s
I do wish to waive that setback requirement.
- - ------------------
DESCRIPTION ANWOR DK&WING OF PROPOSED DEVELOPMENT:
(To _be filled in by individual proposing development)
't
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------------------------- —-----------------------------
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Signature
F, L MC!i�ES
Print or Type Name
`�8d-8s�S
Telephone Number
Date: �G'C O
T'd 909986SIOE OOSSd 398039 dLS:60 LO 20 400

10/03/2007 12:01 9192845326
Oft 02 07 01:39p Coastal
KENLV FARM
Equipment Rental 2527269340
PAGE 02/02
p.2
ADJACENT RIPARIAN PROPERTY OWNER STATEM
(FOR _4 PI E.RIMOORI1VG PILIrVGS; V OATLIFTBO.4 THO L'SF)
1 her_l::y certii'; t;1at J o: a proper:: a.ijacent io
pmperty iocattd at Lat
(\art1zof ropzrtyOtitn
(Lot, Block, Road, etc:
on � t !Zd in
(Waterbody)
(Town an
County)
He hay described to me, as shown below, the development he is proposing at that location, an(d I
have no objections to his proposal. J understand that a pier/mooring pilings,' boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area bf riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
.71V Ck:4c-� jaoc
1
I do not wish to waive
I do wish to waive that setback requirement.
M, SC:K1P ION AND,OK D•ttAWXNi G OF PROPOSED DEVELOPMENT'
(To.befilled in by individual proposing development)
nm oIS, el-4 Pry
l
Signature
'30 s cd
Print or Type Name
-2- 20&-- L-441Y
Telephone Number
Date: l 0 0 ri

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