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❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
El New ❑Modification ❑Complete Reissue ❑Partial Reissue
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
if
Previous permit #_
Date previous permit
El -Rules
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
Cityyt State PJ ZIP 6
S
Phone # ( ) Fax # ( ) Subdivision '` J
Authorized Agent City � ZIP "
_I CW SEW O-PTA E ES ElPTS Phone # ( ) River Basin
Affected ❑ OEA ElHHF ❑ IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body — (nat /ma_n iunkn
I PWS: I FC: )
i
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
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
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no;
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
0 See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name
r
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 [)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
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
Fax: 919-733-1495
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Morehead City District Wilmington District
400 Commerce Ave 127 Cardinal Drive Ext.
Morehead City, NC 28557 Wilmington, NC 28405-3845
202-808-2808/ 1-888ARCOAST 910-796-7215
Fax: 252-247-3330 Fax: 910-395-3964
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05
Y•rr.;, ;y;g..,w
t7R A PIF_FJUNCp F D gC�1� 7' 1 I� 7 J. AITj .
hereby ,
certify that I owrt
property adjactirit to
(Zrirr.re or Property Oti�raeri
property located at
jf���
(Lot, Black, Road, etc.)-- --- --
on
-- -- --- _, in
{To�vu amdiorlC o---.- ��C.
He has desc-ibed to me, as shown below the dev!
location, and, r have no obje`tions to his- proposal. I underst��nd �t�en t he. is ro
p p�stn at t!;at
must be set.bacF a minimum distance of Fifteen f t (I5' f , 3 a Pier.luricovered boat
waived by me. ) from myiarea-or ripaxian act;; unf ss
I do not wish to waive the setback requirement.
1 - I do wish to waive that setback reautrement.
---------------------- ------ ---- --
DESCR%P77ON N-D/OR DRAw:E;G OF PRO ------=-------- --
(To be POSEI:�� D-.E-VE. tE"v�.--------
failed in bt individacaj-posing dac�I�,F�enf)'
f r.
ARErRR �
----------- L
__'
P l� 60,
JUL 1 1 2006 ���
Morehead city�- �
QQ
Siar,ature -I---
Print or Typ.; t•i.l;rrte
I �lephone Nt'irrj[lpr -
I
Date: iC3�G
t
Y DJAC:ENTt' (iY N+� { 5'r r�
pi: ''� MWEP�i- a.
_ ; FOR A PIERILIAf D VERED BOAT I1,1I,7},
I hereby certify that I own property adjacerit to '
_ (tilinre of )?roperfti C�tirz�er
PrI)perty Irxated at `��/ /�ylCC� . / C/ ,
(Lot, Block, Road, etc.) —
on
(Water -body)
(Town audor)Couut '
He has desc-ibed to me, as show; below, the developr;ten[ he i; proposingt
location, and, I have no objections to his; proposal• I understand l;hat a pi'�r/vncov(r boat i
must be set•iack a minimum distance of ritean ,fit (I�') 70 my �rea:ot iaparan ac,;s vn1 ss`
waived by me_
I do qot wish to waive the setback requirement.
r•. j I do wish to waive that setback reourrement.
-------------------
DESCR_LPTI0N -D/OR DRAWING G OF PROPO
(SEll T�EtiE�.C,�P'1(E`vZ;(To be �711eQ in b individual ^r; �o a
� - y sing c.ere_�?p�enc)
C,pr�►�,,-1,
_.z
op'-'
�7 ��P�S� ���� L cos \
More
�- head City
i
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Sigriature
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Print or ,,vie
Telephone Nurnhpr
Date:
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NCDENR
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
Date / - �-C)-7
Applicant Name
Mailing Address
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) ) b 9 0 `V L (- &pjz� C--� Q tLT—
This certific
Signature
--b?
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: 252-808-2808 \ FAX: 252-247-3330 \ Intemet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper
NOT VALID OVER $1,000.00 63379893
ISSUING BRANCH ir,07830I.-MOREHEAD MAIN
DATE •JANUAR'r 04, 2
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OF,
DRAWER: TRAVELERS EXPRESS COMPANY, INC.
P.O. BOX 9476, MINNEAPOLIS, MN 55480
00 AWEE: FIRST INTERSTATE BANK, HELENA, MT
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DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
AND OTHER TERMS THE REVERSE SIDE.
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NOT VALID OVER $1,000.00 6 3 3 7 9 8 9 4
ISSUING BRANCH 607E}301--MOREHEAD MAIN
DATE •JANUARY Q4 , 2on7 93-541/920
PAY TO THE
ORDER OF
LiuuvI,,rt!{ a ,01'r11
BB&T
DRAWER: TRAVELERS EXPRESS COMPANY. INC.
P.O. BOX 9476, MINNEAPOLIS. MN 56480
D EE: FIRST INTERSTATE BANK, HELENA, MT
0.
DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
AND OTHER TERM REVERSE SIDE.
AP
11'633?989411' 1:0920054LLI:OL707L045L092u0
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■ 1HIS DOCUMENT HAS AN ARTII IC IAI. W n I ERMAKK I'RIN HT) ON I111 BACK I I I I. iRON I.OF THE DOCUMENT HAS A MICRO -PRINT SIGNATURE LINE AND BORDER. ABSENCE OF TIiE5E FEATURES WILL INU[CAI F. A COPY. ■