51553_BLAIN, DAVID_20071024

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❑CAMA / ❑DREDGE &FILL n �� 1 �` �, � 1 0,� ` a-15 3
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GEN. PERMIT (� y Previous permit #
El New El Modification El 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 Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # ( )
Authorized Agent
Affected ❑ CW O EW ❑ PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no
Subdivision
City ZIP
❑ ES ❑ PTS Phone # ( ) River Basin
❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
Crit.Hab. yes / no Closest Maj. Wtr. Body
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Ale—nt 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 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:
❑ 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

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor Charles S. Jones, Director William G. Ross Jr., Secretary
Date
Applicant Name
Mailing Address���i
I certify that I have authorized (agent) — ``C to act on my
behalf for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) r)A'�
at (location)�_r_1�
This certifi
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] k Internet: www.nccoastalmanagement.net
M Equal Opportunity 1 Affirmative Action Employer — 50% Recyded 110% Post Consumer Paper

ER
ADJACENT RIPARIAN PROPERTYOL B ATHOvsENT
(FOR A PIER/MOORING PILINGSBO
0 is
I hereby certify that I own property adjacent to�—
(Name of Property Owner)
property located at
Lot, Block, Road, etc.) I A
on \ �� i S. �C�V � « t
(Waterbody) (Town and/or ounty)
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.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
----
[ON AND/OR DRAWING OF PROPOSED DE ]
(To be filled in by individual proposing development)
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Signature
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Print or Type Name
G93_ 13 C'U 3gct-5Ob
Telephone Number
Date: \ o - 1 a - o "1

10/18/2007
Oct 18 07 68:47a
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MOPE RTY OWNER STATFINMNT
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10:20 NEW BERN DISTRICT•OFFICE 4 97454253
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NO.888 D02
252-745-4253 P.2
(FOR A FjrR/MOOiufvqLF F1Z ,s
I }sereby certify that I .own property adj "cent to
(Nsma of Property Qwrnes)
property loraGted at
Lot, Block, Wad, etc.)
_ ounty)
n (Town
oandlor
(yyaterbody) proposing at flat location,
awn below, the dewelapm c he is ding atlijVboatliouse
He bar described to me, as b al. ,=dersandthatapic'r/Mooringp arias acczss ualess
and, i bave na abjcctioz�rrs to his ;,.Pow. o f f"fLecn feet (t 5') om my area of np
must be sot back a ��uul distaa�
.Naived iy cue• e�,lent`
I �!d not arish to waive the setback recce
Y dQ wish to waive that setback requu
D'E�X
-------- IOR DRA,,XWO OP'PROPOSE me
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print or Type N ame
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Telephone Number
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BROAD CREEK CONSTRUCTION
PH.252-745-4252
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MERRiI-;, tiC 28556-9572
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