47194_WHITE, MARK_20070215

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit 40
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permi ssued
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 I SA NCAC
❑ Rules attached.
Applicant Name
Address
City
State ZIP
Phone#(
)�''
~`ti Fax#(_)
Authorized Agent
A i n ui J
❑ CW
❑ EW ❑ PTA I& ES ❑ PTS
Affected
AEC(s):
ElOEA
ElHHF ElIH ❑ UBA ElN/A
❑ PWS:
❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision '
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Mai. Wtr. Body
Type of Project/ Activity
(Scale: )
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 ram
Boathouse/ Boatlift `—
Beach Bulldozing --- -
Other
Shoreline Length
SAM notsure yes no
Sandbags: not sure yes
Moratorium: n/a yes f no
Photos: yes--j-
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
—
—
i
I
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I
—
-
—
— — �. --
� --
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on back regarding River Basin rules.
See note
Agent or Applicant Printed Name
Permit Officer's Signature
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date Expiration Date
Local Planning Jurisdiction 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:
El Tar - Pamlico River Basin Buffer Rules [ Other:
D 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: [phone]
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)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

02r'15/2007 06:22 662-243--4202 ADMIN PAGE 01/01
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North Carolina Department of Environment and Natural Resoumes
Division of Coastal Management
"Aichaea F, i;Wey, Caovernar Charles S, Jones, l koctor W11W G. Ross Jr.; sACro y
Date ' a
AppUrant Name--
Mading Address
I certify that I bave authorized (agent) % Gi v rf V/jC f to act on any
brhalf, for the purpose of applying for and obtaining all CAMA Permits mecesury to
Install or construct (activity)
at (location)
ej- ,, /✓ems 54a,-4 rJ G- c2 F'.S f D
This certification is valid thru (date)
Signature
400 Corr,merce Avenue, Morehead C;ry, North Caroline 28557
Phone, 252-808-28081 FAX: [phone] Internet: www.ri=astaimanagement.nei
An Equal OPwiVnRy 1 Afrrr.ahva action �Mpioysr—"', Reeyeied i i0% Post Cansumer Paper
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I HERBY CERTIFY THAT I OWN PROPERTY ADJACNET TO
(NAME OF PROPERTY OWNER)
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PROPERTY LOCATED AT
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ON
(WATERBODY)
AND/OR COUNTY)
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HE HAS DESCRIBED TO ME AS SHOWN BELOW, THE DEVELOPMENT HE IS
PROPOSING AT THAT LOCATIION AND, I HAVE NO OBJEACTIONS TO HIS
PROPOSAL..
DESCRIPTION AND'OR DRAWING OF PROPOSED
DEVELOPMENT (TO BE FILLED IN BY INDIVIDUAL PROPOSING DFVELOP%4ENT)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I HERBY CERTIFY THAT I OWN PROPERTY ADJACNET TO
(NAME OF PROPERTY OWNER)
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PROPERTY LOCATED AT�
(LOT, BLOCK, RO TC.)
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(WATERBODY) (TONN N AND/OR COUNTY)
HE HAS DESCRIBED TO ME AS SHOWN BELOW, THE DEVELOPMENT HE IS
PROPOSING AT THAT LOCATHON AND, I HAVE NO OBJEACTIONS TO HIS
PROPOSAL..
DESCRIPTION AND'OR DRAWING OF PROPOSED
DEVELOP iV1E1�1 T (TO BE FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMFNT)
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