48120_WALSH, BILL_20070305

1
❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification El Complete Reissue ❑Partial Reissue A
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 # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
ElOEA ElHHF ElIH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
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
�Q ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
3-�-
Previous permit #
Date previous permit issued_
i
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body
❑ Rules
ZIP
River Basin
P1.20-..
kn
(Scale: )
SAV: not sure yes no -
Sandbags: not sure yes no s
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no-
1
\.Jtol^_ tj , See note on back regarding A building permit may be required by: g g River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit*
Application Fee(s) Check#
;Permit Officer's Signature
Issuing Date Expiration Date
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
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

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Certified Fee
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Return ReceiptFee
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(Endorsement Required)
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Restricted Delivery Fee
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'PS Form 3800, June 2002
See Reverse for Insiructions
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed to:
P o fox 1
+�0,K-,To,
A. Signat r
X ❑ Agent
❑ Addressee
B. Re96iv9i&%(Printed Name) C. Date of Delivery
D. Is i�elivery aidress different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
J 4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540

ENR
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
Applicant Name
Mailing Address �I LL
�
I certify that I have authorized (agent) LLC--- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) l 10 LL-v--VQC2
This certification is valid thru (date)
Signature
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

09/11/2006 10:39 2526330810 RAYMOND GOLDMAN CO PAGE 01
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to}L�j- �s
(Name of Property Owner)
property located at 10 l t- 1000r�l eouor 21 Vf
1 (Lot, Mock, Road, etc.)'
on f�-i� '1 ��``1!I ,_ _.._• in O 41AIP21 60L#..-I'I 1 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in 6y individual proposing development)
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10( xI' V,t",J [t" ,®vL,� vi 1T4
(7) Tx_195' WitJG c.4�;p '7".
POL 7x-poit��_�L
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