54180_LAWRENCE, THOMAS_20090630

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11 C:AMA / ❑ DREDGE & FILL 5 AI 4��
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GENERAL PERMIT � Previous permit #
ENew ❑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 `
O Rules attached.
Applicant Name }
pp ��r.•c�+c• �_ r.�tvir,'!r iJ Project Location: County
1•,
Address ! ' ± i w i - . - *'•L - Street Address/ State Road/ Lot #(s)
City State ZIP a f
Phone # ( ) ? I ', i Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # O x River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A iAd'.
J Wtr. Bod ,
y (nat /man /unkn)
❑ PWS: ❑FC: i
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: j(j )
Pier dock len h '
Platf
Fing
MEN
No
0
Groilength
m
MEN
ON
No
Bulk !'e'udm/ Riprap length
avg distance offshore
OMMEN
0
ON
0
ME
MMM
max distance offshore-
ME
IN
Basin
NEW -- M
MEN
MEN M
Boat ramp �IMMMI ME
w
Boat
Beac ME ME ME MEMO
ME
Othe
ME ME ME ME
M M
Shor
SAV:
Sand MEN
M
Mo
Phot No
Waiv
A building permit may be required by: ; ? „,� r
❑ See note on
back regarding River Basin rules.
\�.
Notes/ Special Conditions ! :260
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Agent or Applicant'Frinted Name
Signature Please read compliance statement on back of permit"
-zws. oci Z
Application Fee(s) Check #
PermitOfficer'sBignature
3
Issuing Date Expiration Date
L r
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, certifythat this 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
Fax: [phone]
Location:
(Serves: Carteret, Craven, Onslow -above
2728 Capital Blvd.
New River Inlet- and Pamlico Counties)
Raleigh, NC 27604
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

MAY-16-2009 11:44 From:B&C SETTLEMENTS 9193177839 To:252 728 6260
Mali Ir, •09 09:40a Carolina Wireless 252-920-G260
P.2/2
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOAYZIFTIBOATHOUSE)
I hereby certify that 1 own property adjacent to 1-11*1
(Name of Property Owner)
property located at
(trot,
Oil k col , in
(Waterbody)
Applicant's phone #: JJ"2 Zaq 3 /9
Ilock, Road, etc.)
kAj=ze , N.C.
(Town and/ r County)
Mailing Address: — A
fie has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. 1 understand that a pier/mooring pilings / boadift / 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.) �4/ 9S" lcN, f .4 -/ 6
I do n wish to waive �� u 10
1/ i do wish to waive that setback requirement.
•.— ------
'gyp-CPTf^lai'I/flP. til�lY?r!C OF l)1<iUPOS1 D DEVELOPMENT:
a e _e r '� n ho ip t='d's% d �: .Si..-i �YC:�neess.ss;; ;
e {.Aed �.._.. i �_ Aiseizwa°oa as ,,..._..,
a
k � ;
E 7 1
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-
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ation I'--- Property 10--w-ler
crl>�-; y _
F
Vialling Address
3 n one NuTnDr_
Signature
Date
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Dace
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
`• f c �% s
(Name of Property Owner)
property located at _ l ,�,�` y
(Lot, Block, Road, etc.) '
on r N.C.
(Waterbody) ( own and/or County)
Applicant's phone #:JS 3-7) � - 346 i Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and,
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
--------------------------------------- 1 /YI oo r"/n g
-------------� MPo i'.-ir -------------------------------------------------
DESCRIPTION-AND/OR DRAWING OF hOPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------
(Information for Property Owner Applying
for Permit) -
Mailing Address
City/State/Zip
S ,ti
Teieph no Number
Signature 5 7- v Of( Date
-xV,
------------------------------------------------
(Riparian Property Owner Information)
Signature
Z'rc4.It��L wts
c Print or Type Name
7 �
Telephone Number
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THDMAS LA WnENCDL NCE '~
Lizzie Lawrence NCD 2513486
1286 Island Rd P L 1549623
Harkers Island, NC 52 8531 -728'3419 3002
66-21/530
Pay to the / +� (BRANCH 77513
Order of (O �( 7
� ate
i
WACHovrA
Wachovi Dollars 8r
wachovia.cc Bank, N.A.
om
For I
1:053000 2191'
. 105t,6854 2640?u■_

MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE'S NAME:
f �av�'lo�
I ���; fP r�C
PERMIT # 5 LJ lea
LOCATION:
FIELD REP.
MONITORED BY
PHONE: 2-y —?QCtq DATE REPORTEDLY COMPLETE: L05
DATE OF INSPECTION I
1) 49csiurele
red dimensions of the development differ from those indicated in the permit and workplat?
one].
Ice]
F
N
2) SEDIMENTATIO EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? E /NO [circle one]
3)
COMMENT:
FUTUR NITORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? NO [circle one].

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