52141_BAYARD, ROB_20080207

❑ CAMA / ❑ DREDGE & FILL 61 1
GENERAL PERMIT �V Previous permit #
El New [--]Modification ❑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 i-., ',
City State ZIP
Phone # ( ) Fax # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
AEC(s):
OEA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW:
yes / no PNA yes / no
DES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: /)0n <° )
Pier (dock) length
1
Platform(s)
Finger pier(s) 1
Groin length
number
lr �-
Bulkhead/ Riprap length - •
avg distance offshore
max distance offshore YJ
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
-
_
i
''�
i
I
,
I
'
Shoreline Length
SAV: not sure yes no --
Sandbags: not sure yes no --'i
Moratorium: n/a yes no i
Photos: yes no r 1
Waiver Attached: yes no Ill," —
A building permit may be required by: See note on back regarding River Basin rules.
Notes/ Special Conditions
^� a
Agent or Applicant Printed Nam ✓
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
PermitOfficer's Signatures
Issuing Date Expiration Date
�.. 1
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, 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/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
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)
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

ADJACENT RIEPARMN PROPERTY OV44M STATEMENT
(FOR APM"OOR VGPHING►So%OATLUMNOA7WoUSEj
I hereby ratify that I awn properly adja x oMo c Q n Jyfo- b-u- arJ -s
WMW of Prop" Oviaw)
property located at
O K Mack Roaal9 eft-)
on rc bi ,in f��� (i°_I'Ii � , Dl cm l IC r� �� -N.C.
M om) CrOW079AWOr City)
He has descaibed to me, as shown below, the devil kipme nt he is proposing at dw loc a ion, and, I
have no objections to his proposal. I understand *9 a pierlmooring pilings / boatiift / boathouse
must be set back a mininnun distance of fifteen feet (15' fium my area o€fipaaaa access unless
waived by me. (Ifyou wish tin w the seMadk, you most ftWW the appropriate blink
below.)
I do not wish to waive
142 wish to waive fhat setback requirement
WSCItD*T ON ANDIOR DRAWING OF PROPOSED D LOPMEW:
C� rG�iozd- 5� i►-� pow L
7rDpOSecj V i I-) I
0 maidy 0� 2-1 E S P
De� I`' a+ wall �s I
�111�j 11 loc-,
jkfC C ii41e-.
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4,', )CIa---�� 1)l4(
P6nfor Type Name
- - WephoneNumber
Date. l g �Jur1 Gr4 �

From:
05/26/2010 05:37 #229 P.002/002
North Carolina. Department of E"nvirohment and Natural Resources
Division of Coastal Management
Mlchael F. Easley, Govemor Charles S. Jones, Director William G, Ross Jr., Sea tary
'Date
AppReaut A6 I? M�TA -
WSg Address —JAI -A h At A
I certify that I have authorized (ages act on my
behalf, for the purpose of apptyiAg for and obtaining A CAMA Permits necessary to
install or cox
sit (location)
This certification is v ate)
Signature
one T_ 406 vmmem Avenue, Morehead pity, North arblina 66I s=
Phone: 7.5MO8-2800 t FAX: [phone] intemet; wwYocoasmlmwnlgement.,
An E4ud pporW*1 AffmrreMktivrl gmom=00% d.4 Pat c mneP.Ge

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PAY
TO THE
ORDER OF
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T' __ c n It ' 1; c e �d,d
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141 TARA TRL
GRANTSBORO, NC 28529
4139
DATE 66-30/531
472
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