49760_VAUGHN, DAVID_20070719

4�5 _
❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
[!]New ❑Modification El Complete Reissue []Partial Reissue Date previous permit issued
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
❑ Rules attached.
Applicant Name
Address
City
1
State
ZIP
Phone # O
r —,�
`;� Fax # (_)
Authorized Agent
❑ CW
❑ EW
❑ �TA ❑ ES
❑ PTS
Affected
AEC(s): [IOEA
ElHHF
❑ IH ❑ URA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA
yes / no
Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length 1 ��
Platforms)
Finger pier(s)
Groin length - - -.
number
i
Bulkhead/ Riprap length `I
avg distance offshore
max distance offshore t
r rt,
Basin, channel
cubic yards
Boat ramp C:
Boathouse/ Boatlift i
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no t
Moratorium: n/a yes l b
Photos: yes (no.
Waiver Attached: I yes
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#
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision Y;
'1
City ZIP
Phone # O 1� ��/f River Basin
Adj. Wtr. Body, / (nat /man` /unkn)
Closest Maj. Wtr. Body
(Scale: f ) 0 rl I
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiratio Date
i�fi(J &(
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, 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 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

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. -:> —?
Applicant Name QA, i O \1 -n';
Mailing Address
N O 2-} h 2 5 e5 z; i
P-1r -- Vj\ji I I I N Z, 2 �1 5 �5
I certify that I have authorized (agent) 01 v') g< < it, � Dr" 35I h :�) to act on my
behalf, for the purpose of applying for and obtaining all CANIA Permits necessary to
install or construct (activity)),; � � C) -' 4-- j<-.5 '
at (location)
G 1) e. h I-Z L o --,VZ- I 7
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] i FAX [phone] Intemet: www.nccoastalmanagement.net
An Equal Gpp,- cunity 1 Arnrrnative Action Employer - 50 a Recyded 1 10% Post Consumer Paper

ADJACENT RIPARIAN, PROPERTY OWNER STATEMEN'T
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Ux� k 0 U a , .5, h 61 's
(Name of Property Owner or Applicant)
Mailing address if different from location address N 2:5 S w1E:
(town, state and zip) r��- ^"� ` 1 �� N ' 2'1 <Ts S
phone numbers you can be reached at 2S 2 - S
property located at a 6
(Lot, Block, Road, etc.)
on �a.7 �-sa 4L— , in N.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.
A
.
I do wish to waive that setback requirement.
initials
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
✓ t (Cl rY �`` �oG Jaw D �.',�.; ... 5 00 c�
------------------------------------ ------------------------------- �-----------------------
e -
Signature JT
Print or Type Name
l� & d3
Telephone Nu ber
Date: b7

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR LAMA MINOR PERMITS
hereby certify that I own property adjacent to _�1 �v ► n 1
(Name of Property Owner)
property located at \A
Addr s, lot, Block, Road, etc.)
on ' ���u� �CC; (4 in N.C.
(Water body) (Town and/or County)
He has described to me as shown in the attached application and project dra *V(s), the development
he is proposing at that location, and, I have no ot� ections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature f
Sr
Print or Type Name
Te ephone Number
Date
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25 S ,(.4 rJ IL RAmP

MUD BUCKET DREDGING, INC.
PH. 252-241-1504
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557
PAY
TO THE N ,/
ORDER OF
2379
66-112/531
1 t BRANCH 02201
DATE
OP
$ 'Soo
DOLLARS
BRAN �y,T�mMPAN
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