54651_KINGERY, WILLIAM_20091001

❑ CAMA / ❑ DREDGE & FILL ��� 5:11651
GENERAL PERMIT Previous permit#
❑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 enviro ental concern pursuant to 15A NCAC
� ❑Rules attached.
Applicant Name_ , _ C�__,% I
_l'lX/ Project Location: County
Address `I / 1' f Street Address/ State Road/ Lot #(s)
City t_. State j E ZIP.
J
r
Phone # ( ) ) ... �l i1 Fax # ( ) Subdivision
Authorized Agent
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
City ZIP
Phone # O River Basin f
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
i
Type of Project/ Activity
(Scale:
-Barring a major shoreline change due —
to a storm or other significant event,
the alignment of this structure must be
approved by a DCM Rep. within 120
days of the onset of construction.
)
Pier (dock) length
Platform(s)
Fingerpier(s)
Groin length
number
Bulkhead/ Riprap length I
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
-
_
_
I
—
1
i
,
Shoreline Length l i d
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no j
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: -— ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
may.
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature iaQw
Issuing Date Txpiration 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, 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/ 1-888-4RCOAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Ar 's
h (Name of Property Owner) I
_-
property W, `-) ly
(Lot, Block, Road, etc.)
onin C-`>-d~ l%U , N.C.
(Waterbody) (Town and/or County)
Applicant's P b 13�licant'hone #: A6"L� � Mailing Address: ' -,ny'- ob
v C
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.)
LI 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)
mv)
(Information for Property Owner Applying
for Permit)
Mailing Address
C
City/State/Zip
Telephone Number
Signature Date
(Riparian Property Owner Informa
Print or Type Name
�J. Telephone Number
Date

�•� CJGG� 1 JJJV . v �✓� a. • . ✓.+...ate a a
WIWA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Esslsy, Governor
James H. Gregson, Director William G_ Ross Jr., Secretary
Date a, G
Applicant Name
Mailing Address
— to act on my
f certify that Y have authorized (agent) T-tM
behalf, for the purpose of applying for and obtaining All CA MA Permits necessary to
install or construct (activity)
at (location) r`EN
�141J ! 02o f o
This certil
Signature
400 Commerce
. Avenue, Morehead
Internet: t�
rth Carolina 28557
Phone[phone] � FAX[phone] www.ncca staimanagement.net
An Equal Oppanunity % Attimiative Action Employer - 50% RKYCW % 10% Pa,t t;onsurer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATH�tOJUjSII)
I hereby certify that I own property adjacent to
I (Name of Property Owner)
property located at Lg N 7`i o v d �— ki,\ 2 i 1�
(Lot, Block, Road, etc-)
on �G I 1 �.� i:, i� , in P �, Z '� i2 1 �' , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:,R,� Mailing Address: i
�kh
NC Aet�-lc
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 (I T) 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)
P6��
-cco
(Information for Property Owner Applying
for Permit)
r]
Mailing Address
City/State/Zip
--------------------------------------------------------
(Riparian Property Owner Information)
—� (l (Signature
Pet S e- 1 0._. �wLv1C1 �\I X
Print or Type Name
Telephone Number
zov17 x
Date

OUTER BANKS MARINE CONSTRUCTION, INC
1501 FIRST AVE
MOREHEAD CITY, NC 28557
[phone]
PAY TO THE
ORDER OF
FIRST CITIZENS BANK
firstcitizens.com
3736
66-30/531
137
9/9Rn009
$ * * 200.00
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D.E.N.R.
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