56068_MMJH, LLC_20100805

❑ CAMA / ❑ DREDGE & FILL 4f x e /D /-iS
GENERAL PERMIT tv Previous permit#
El New ❑Modification El 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
�` j Project Location: Coun
Applicant Name J >' , J V j ; ,i ; i I tY
Rules attached.
"i
Address ,), x
5- 0 J
Street Address/ State Road/ Lot #(s)
City
0 1 116
State 'v C ZIP
Phone # 73 Fax # (
Subdivision
Authorized Agent
City / v L'�, L i 1 ZIP
❑ CW ❑ EW
❑ PTA El ES ElPTS
Phone # ( )` River Basin
Affected
l
❑ OEA ❑ HHF
AEC(s):
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body `" ;``-, o
(natman /unkn_ /
/
ORW: yes / no PNA
yes / no Crit.Hab. yes / no .
Closest Maj. Wtr. Body �, I
t
Agent or Applicant Printed Name
4ignature Please read compliance stat ment'on back of permit 1
Application Fee(s) Check #
Permit. Officer's Signature
,.
Issuing'''D�a(te
EExj�piir�atttiioorr'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
Iandowner(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 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.
Raleigh, NC 27604
919-733-2293
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

AGA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owner Applying for Permit:
/1/) 1;4 Z- <�
Mailing Address:
P (2 Y o
I certify that I have authorized (agent) t/ /t'ZIIJ C-G
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
11 A /i 4 i ,
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
�1 ---r- /-�- / v ""-
Property Owner Signature
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOOPJIVGPILINGSIBOATLIFTIBOATHO USE)
I hereby certify that I own property adjacent to
1274- (Naffie of Property Owner)
property located at 17-9 L,
(Lot, Block, Road, etc-)------'
on
N.C.
(Waterbody) in
(Town and/or County)
Applicant's phone #: Mailing Address:
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.)
vl-�- 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)
(Information for Property Owner Applying
for Permit)
Mailing Address
17
City/State/Zip
Telephone Number
Signature
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
-�14 - 4 716
Telephone Number
T Z114
Date
N1Z-Lx7-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to
5
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on in `J r- :.s_' N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: ' €'
He has described to me, as shown below, the development he is proposing at that location, and, I
haveno 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.)
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)
"A
(Information for Property Owner Applying
for Permit)
J1EJ .X
Mailing Address
;.�•
City/State/Zip
Telephone Number
Signature Date
i
(Riparian Property Owner Inform tion)
Signature
Print or^ Type me
Telephone Number
Date

NC Division of Coastal h19t. Habitat Impact Computer Sheet
Applicant: MMJH, LLC
Date: August 5, 2010
General Permit #: 56068C
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
tem im acts)
impact amount)
temp impacts)
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
169
169
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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TR PRESCOTT MARINE CONSTRUCTION LLC
545 ALLIGATOR LOOP RD 252-745-7135
MERRITT, NG 28556
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