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-�. ❑ CAMA / ❑ DREDGE & FILL 510
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GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 NameNJ
Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O - Fax # (
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab, yes / no
Subdivision
City
ZIP
Phone,# ( ) River asm
Adj. Wt(nat man unkn
Closest Maj. Wtr. Body �^ i
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
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Permit Officer's Signature
Issuing Date
Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name
Y
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
landowners).
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: 252-247-3330
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
(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: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)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
I CDENR
North Caroiir a Department of Environment and Natural Resources
I,jon ac Coastal Managem nt T� Fn
�lich2ei �BSIry, GGVrr�Gl charles S. Jones, Director �5Ir,
�..
AU 3 0 2007
Morehead City DUA
Applicant ame
1°✓l ling Address
l certify that I ha-ve .auxboriaes;a (agent)
to act or, lw.v
behalf, for the purpose elf appIlyixng for and obtaining all CAMA. Permits necessary to
install or construct (ar-t:h ity)
at (tocatioar) aa7? ot--D C-PoSSF 0 64 ` -*D - -
This certification is valid thru (date)
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Or�; ;ommeice Avenue, Morehead City, North Carolina 28557
Pnnnp- 252-247-3330 \ Internet: www accoastalmanagement.net
+ Aug 22 07 10:11p Nancy Sanford 919-471-4615 p.1
FROM ' FAX NO. : 252-522-3183 'Aug. 16 2007 06:19PM P1
s: i !11J11•XLiEN �6,eAi ,tAL Pic#JFT1 , S �J 1Tl�i,l.� �S�� r q � ?,
,FOR A PIF-RJUNCOVERED BOil T I+II:X)
I hcreb v c;- a , y chat I own ,ro rt• ad ac. rrt to
(N..inre of priky 01, Up 0.
prr)perty located at
(lot, Block, Road, etc.)
(ti ateb�d;) (To-vPu a e�i -' A o� l.(�y�ty}
He has des; ibe l: •try me, as shauii beio4�, the .devebpr;ient he: i� .Rrr� i;,sin}. �;t: th
loG3tiorl, and, t Rave na aoj: uoas.io. his=.pr000s�t..1 uriif��;sU^:rid Char. a i F ,ciiteo�ere [yq .I%�z
s must be sef�ack a rYrirli:rritim distance n.f ri't�eya ce~t (lj') ribi".--iarra'af i'pariain ac�. zii Ss: ` : .
l waived by me. .
I do ng *i§4 t9 viwv-the:seiba�k re�Uireme�i. +
1 I V�is1i :to _ve that see ack retluir--riterit. i
�. .:O' 2007
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SignaCure
Frith or 7 yp-- N,.�rne
Telephone Nu11 bj'r
,Date;
RFax sent by 2}5-�22478759 Alan Shelor Real Est 08/27/07 88:45 Pg: 2
�. �,z�K .I'
y''' (FORA P1' R1UArCO '' '
�E'1ZED BOr! 7' zllFz)
that
I hereby cerciPY ! oWr1 ro ,
P �Ry adj acer � t to��
� 's
(_Nhnie of Property (�ti�uer)
Pn{�PenY loGatcd at? Q
$1
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on etc.
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He has desc-ibed to me, as shown below, the dev`(o�yr�1Gnt he. is prosirl7 ;
lc�c.3tion, and, r have no objections to his, pr000sni. I and } at that
erst<,nd r •' _
- �h3t a
MUSE beset zcr/uric v
tack o er.
l waived by me a mtnArnurn dtstaned or rttte� t (1,�') r` on my' 'a -or tLip a17 � bQai �S
do qot wish to waive t-he ,eEba,ck rEouirernent. f '"
' I dg wish to waive tha 3 0 2
t Setback requirement. � �007. ,
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DID --N' IOR r)RA"V G OF PROPC?SED DEVI DLO .AYLF, T: +Y ervl
(To be fLleci in by' Hindi-vdu4zl prr;yosfng d�rP!��p�r7etzt)
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