51071_VALENTINE, ED_20070911

❑ CAMA / ❑ DREDGE & FILL
r. GENERAL PERMIT
El New ❑Modification ❑Complete Reissue ❑Partial Rei sue
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
Applicant Name
Address
City_ _______
State` ZIP
Phone # ( )
Fax # O
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no.
PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision- -
CiZIP
Phone # ( ) River Basin L� C
Adj. Wtr. Body . (nat /man /unkn)
Closest Maj. Wtr. Body f "-Lug
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Agent or Applicant Printed Name �.
Signature -- Please read compliance statement on� ack of permit"
/ Acl�.
Pe`rmitOfficer's Signature
Issuing Date
Expiration Date
Application Fee(s)
Check # Local PlanningJurisdiction
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOIISE)
I hereby certify that I own property adjacent to Eo V'al J j,) I J Az.' 's
(Name of Property Owner)
property located at 3 (t aglL, r A% % & iy 01,' f vi- ,
(Lot, Block, Road, etc.)
on 15 L 0 A/)) r A , in 9J VA& B:-. o /1/"I /?6;-nN G P, N I' /►1N.C.
(Waterbody) (Town and/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/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
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Telephone Number �J
Date: V
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Signature
Print or Type Name
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Telephone Number �J
Date: V

North Carolina. Department of Environment and Natural ResourcesT°�
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Direc`?r William G. Ross Jr., Secretary
Date ? �/© C)
Applicant Name U" 1,eli71NE
Mailing Address �j�. PL-A -r A--r / © KJ
I certify that I have authorized (agent) j'�1�� �771,' 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) SA M E-
SgIFF LI F i
This certification is valid thru (day)
Signature
�- i0 0S
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

r:
North -Carolina Department of Environment and Natural Resources f .zt`z
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, D'treC` :)r William G. Ross Jr., Secretary
Date ?—/c
C
Applicant Name V %�Le� -Tt � r
Mailing Address 50. (O PL.,Alj-rA--TIOKJ
AJC-
I certify that I have authorized (agent) j'H A / ��M� / to act on my
behalf, for the purpose of applying for and obtaining all f7AMA Permits necessary to
install or construct (activity) K r
at (location)
This certification is
Signature
thru (d#e)
L / F '7-
9- /a 08
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] i Intemet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to r V r% L L <?///l�G 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on i S.L.d a/i ' �- /i �= , in l� � i /56w/� G/�? t/c =/Z'/ , N.C.
(Waterbody) (Town and/or County)
He has descizbed 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/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
3 2 . -- I I '
NCV-
�,A`1 � -�r
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1
Signature
Print or Type Name
Telephone Number
Date:
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