51588_HOLLAND, JOEY_20071022

11 CAMA / ElDREDGE & FILL '� ��' i �6 ' + °) - C
GENERAL PERMIT ��/ WrPr'e0v'ious permit #
❑New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As auporized 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 . ! i "' Project Location: County
Address
City l State ZIP i� 1
Phone # O IFax # (
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑FC:
ORW:
yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP ) L-
Phone # River Basin ' % i
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: �� )
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
Beach Bulldozing
Other
-
f
—
_1
J
r�
i
Shoreline Length _
SAV: not sure yes no I —
Sandbags: not sure yes no -
Moratorium: n/a yes no__
Photos: yes Po _ -
Waiver Attached: yes no —
r /
A building permit may be required by: !� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or ApplicantPrinted Name
Signature Please read compliance statement on back of permit **
Application Fee(s) Check #
PermitOfficer's Signature
Issuing Date ! %txpiration Date
Local Planning Jurisdiction Rover File Name

Statement of Compliance and Consistency *14
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, certifythatthis 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
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

9192845326
KENLY FARM
PAGE 02/04
10/15/2007 12:59
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A w
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor James H, Gregson, Director William G. Ross Jr., Secretary
Date
ApplicAnt_Natne
Mailing' Address
I certify that I have authorized (ageut) ��VE UJI566 to act on my
behalf, for the purpose of applying for and obtaining all CAMA. Permits necessary to
install orcoustruct(activity)-
at
(location) /mod
This certification is valid tbru date)
,., ,— ---- �...
Signatu
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Intemet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Aclion Employer — 50% Recycled 1 10% Past Consumer Paper

10/15/2007 12:59 9192845326 KENLY FARM PAGE 03/04
TY
(FOR A PIER/LTr'`I ^0 .$O�iT I117}
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i iFicu'i czci Fy that I o'r+rl properly adldc:_rt to ®idl1C..�• S
rrn ILY loC2ted at LIAIP, '-G'IJuer 41e � /VCl _. _..
(L.ot, Black., Road, etc.)
(W'aterbodv) (Tvaudlarl Coumt' _ .
- - - He has desc.Zbed to me, a-s snown belo'x, the development he -is proposing ar ttat
location, and, I have- no objections to his pro-pos—'L1. I understand fhat a pieriuncovered boat U
nusc be set back a minimum distend or fifteen rc--r (15') from my jarea of riparian ac=s unless
waived by me.
I d4_ not wish to wive the sc back—Z re uirement.
I _d_Q Fish to waive that setback requirement.
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D SCF�YPTIt� ti �:'�77/OR DRA'WTN G OF PROPOSED; pE%ELOP.'YfF—'v-T:
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Signature
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10/15/2007 12:59 9192845326 KENLY FARM PAGE 04/04
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