49865_WRAY, DICK_20070820

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❑CAMA / ❑ DREDGE & FILL 4
r. 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 Name
Address
CityState ZIP
Phone # ( ) Fax # ( )
Authorized Agent E
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
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
SAV: not sure yes no
Sandbags: not sure yes <`no
Moratorium: n/a yes ono
Photos: yes ( no
Waiver Attached: yes no
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
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body `~
(Scale: r " , e' )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date ! Ex iration Date r I
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 I) 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, certifythat 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
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/ 1-888-4RCOAST
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
Applicant Name M 0- 0,c k L--)a'�)
Mailing Address
I certify that I have authorized (agent) va� ��-�� ����� to act on my
behalf, for the purpose of applying for and obtaining all CAINIA Permits necessary to
install or construct (activity) e0nr5-�sZ �"Y ��� ���``'flC-Q-- '
at (location) Z zS (� h ` 4-E- W�5
This certification is valid thru (date)
Signature �2, I ,,� j
400 Commerce Avenue, tvlolehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
+ An Equal OppaTunity 1 Aifirmalive Adon Employer - 50% Recycled 110% post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to '�l C- I-t/a uz :>
(Name of Property Owner)
property located at 1,2;? / N r r A S i-t _iz I V r
(Lot, Block, Road, etc.)
on C'4 ig A in /K Np i S H ©tom , 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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
----------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Q> 4
✓ ` V ` ^i a4 c �- s� L L Z 1" -C !2 . I fl l fil ��F i S ►.,5 C�1 X, LL—
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---- -------- --- ----------------------
---- & /-,,(7 -
/ Signature
1� P& T I Z L F,,N NOW
Print or Type Name
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWT1ErR. STAT'EMXNT
(F'OR _� PIERIMOO RI,'�G" MUNGS/BOAT "IT/ OATHOUSE)
I hereby certify that I owt► property adjacent to A Is
(Name of Property Owner)
property located at ��t i 1l I.�-4s•� - — ---
(C.,oi, Block, Road, etc.)
N.C.
on in (Waterbody) (Town and/or t'ouuty)
l le has dofwribed to me, ar, shover below, the development he i,; proposing at that location, and. i
have no onpection4 to his proposal. I understand that a pier/moofing pilings / boatli i boazhct
must be ,et back a zrtinimurn distance of fifteen feet. (1 S') from my area of riparian access unless
vraided ny me. (,(you wish to waive the setbaek, you must initial the appropriate blank
below.)
I do not wish to waive
r
� y i i(I wish to H•aive that setback reyuirement-
f/---------DESCRIPTIO'AND/OR DRAWING OF -PROPOSED -DEVELOPMENT: - ---�
(To be filled in by individual proposing development)
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rv�o}D�K�.�
1H v
Prit;t or Type Name
relephoneNumher
Date: � - t% C: ,'
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MUD BUCKET DREDGING, INC.
PH.252-241-1504
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557
2430
66-112/531
BRANCH 02201
PAY DATE
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