55798_LANE, GHERMON_20100617

/01616
W❑CAMA / ❑ DREDGE & FILL �'/
GENERAL PERMIT �(/ Previous permit #
L-]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 I SA NCAC
-Rules attached.
Applicant Name k'�) �r '\ Project Location: County (%?( (!') /
Address
n V'`'1 V t` C C cam. ' y Street Address/ State Road/ Lot #(s)
City 1 V 1{� 1 State �� (. ZIP -
Phone # (� �'1 r ' Fax #
f ��//
Authorized Agent F% j� ! V ;';:} I �} �/ �y/ I ;
Affected ❑ CW ❑7 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 `0 rf'i' V1 �� 10 f.`
Pier(dock)length- / /,
Platf
Finge
Groin
Bulkl
Basir
Boat
Boat
Beac
Oth(
Shor
SAV:
Sand
Mor.
Phot
Wain
Subdivision
City ZIP
Phone # () River Basin(/t
Adj. Wtr. Body E y , ! V t naj ll /man /unkn)
Closest Maj. Wtr. Bodyf
(Scale:
�Q )
orm s
i
i
r pier(s)
i
length —
number -- --- _ - - —
iead/ Riprap length - - - --
av distance offshore
g - -- -
i I
max distance offshore--
i L
,channel
cubic yards I -
ramp
louse/ Boatlift V
i Bulldozing _ -
i -- — --
aline Length Nnot sure yes n
gags: not sure yes ? no Ae - 1
.torium: n/a yes no
�s: yes no }�{��+g, + -- --- --- - -
or Attarharh — n __ _ - — - -
A building permit may be required by:
Notes/ Special Conditions
A14;n,,c
OAa
U --A'
Agent or Applicant Printed Naga
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
PermitOfficer�' Siatu n
z �;i�/0(
suing Datel. n Expi tion D e
Local PlanningJurisdiction Rover File Name
A building permit may be required by:
Notes/ Special Conditions
A14;n,,c
OAa
U --A'
Agent or Applicant Printed Naga
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
PermitOfficer�' Siatu n
z �;i�/0(
suing Datel. n Expi tion D e
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 [)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 complywith 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

/,&'X + 66KK i% L;,h<-
Page 1 of 1
Site: 264 OSWELL BRINSON RD
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(0 box LA501 5
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Property Details:
START
13430
UNIQUEID
13171
ACCTNUM
20496
LASTNAME
11 LANE, GHERMON L
FIRSTNAME
ICAREOF
IIAND GLENDA W
ADDR1
I P O BOX 207
ADDR2
CITY
DOVER
STATE
INC
ZIP
28526
PARRECNUM
1125
-1
NAME
LANE, GHERMON L
MAPNO
K051-13
CONTROLNUM
IPIN
ILD03
CLSCODE
DISTTOWN
INSERT
K051
DBLCtR
264
BLOCK
13
PARCELNO
SITEADDR
264 OSWELL BRINSON RD
SITUSADDR
SITUSROAD
110SWELL BRINSON RD
EXEMPT
SURVEY ATTACHED
LEGDESC7
SR 1331 BAY RIVER
LEGDESC2
TOTACRES
j 0 IICRNTTOTUSE
0
CRNTTOTDEF
0
CRNTLANDVA
78750
CRNTBLDGVA
74389
CRNTOBLDGV
1121175
TOTCRNTVAL
174314
FIRECODE
F
HOUSECODE
P
SEWERCODE
6/28/1999
SALEAMNT
78500
SALEDATE
SALEDATE2 1172,500
ISALE CODE
S
ROADNUM
1331
PCTCOMP 11100
WILLBOOK 110
WILLPAGE 110
DB_PG
345/400
DEEDBOOK 11345
DEEDPAGE
400
PLAT
MOBHOME
0
http://www2. undersys. com/scriptsltestadvlusiwebpe. dlllusi?formis=ptmap&MouseX=327&... 6/3/2010

Postal
oCERTIFIED
MAIL.
RECEIPT
(Domestic
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Farm S
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Postage
Certified Fee
4NC
C
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Return Receipt Fee
(Endorsement Required)re�o�o
Postmark
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Restricted Delivery Fee
(Endorsement Required)
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Total Postage & Fees
5 /
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To
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Street, Apt. o.: .----- -------I-�
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-aJ56V.
PS Form :ir June 2002

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date 6 Ll n
Applicant Name 6 ev �^b1� ` 1'\V%C
Mailing Address 2 6
Ae,nv,H ' Nc• )15 7 �
I certify that I have authorized (agent) TN M �, \r ,ht, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) 5 0\w. C' n 5
a
This certification is valid thru (date)
Signature k
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www. nccoastalmanagement. not
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit: L Nye,
Address of Property: ),64 O S we �\ 1 J s� h S ah IC
Mery , N ( .
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this letter.
,l I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
90 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags
must be set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Applicant Information)
po VOX I o
Mailing Address
X )3571
City/State/Zip
a 5-1- a� Cl - I W a�
Telephone Number
6 7110
Date
XiNse fe 01M �0
(Riparian Prope Owner Information)
7
Signature
Print or Type Name
Telephone Nu ber
x//�
�U
Date
i Yov,

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Label/Receipt Number: 7006 0100 0004 9789 7260
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isx 1114
PO BOX 190 j %j) 66-30/531
ORIENTAL, NC 28571 (7 1(/ 472
Date
Pay to the L N $ 100, 06
Order of NO
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Foull 1" %jy\bTA VVNb luo Dollars
First Citizens
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Bank
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For FA+v%S .� L,he eJw,;� ------------ "p
i:0531003001:00471202L254n' OLLL4
:r

NC fllvislion of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Ghermon Lane
Date: June 17, 2010
General Permit #: 55798C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
80
80
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑