56329_MITCHELL, JOHN_20100820

❑ CAMA / 171 DREDGE & FILL
GENERAL PERMIT \ /� Previous permit #
El New EDModification ❑Complete Reissue El Partial Reissue / ; Date previous permit issued
/ i
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.
i
n
Applicant Name
Address
City
State ZIP
Phone # ( )
Fax # (_~)
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
Project Location: County
r
Street Address/ State Road/ Lot #(s)
Subdivision
CityZIP
Phone # River Basin / t!
1( j-
Adj. Wtr. Body !�( ` (nat /man /unkn)
Closest Maj. Wtr. Body C
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s) --- j - -- —
16
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
1.
—
--
—
-
n'
J
I
Shoreline Length
f r -
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: �' r /l^ ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
sl
Agent or Applicant Printed Name
Permit Officer's Signature /
Signature ** Please read compliance statement on back of permit ** Issuing Date
Application Fee(s) Check # Local PlanningJurisdiction
Expiration Date
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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-8884RCOAST
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

■ Complete items 1, 2, and 3. Also complete
i item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we. can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
cy
A. Signature
X ❑ Agent
❑ Addressee
B. Received bo Printed Name) C. Date of Delivery
e'
D. Is delivery address different fr9m iterFM ❑ Yes
If YES, enter delivery address below: p�0, l`
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (F_xtra Fee) ❑ Yes
2. Article Number 7007 0710 0001 5273 2554
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
• Sender: Please print your name, ac

(FOR A PIERMOORI'NG PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Jo n lida th Tc 's
(Name of Property Owner)
property located at Z a-r 20
4(,4 .3A y S o,e�s 12-0
(Lot, Block, Road, etc.)
on 4�5—reeA , in 11AV^111777
(Waterbody) (Town and/or County)
Applicant's phone #C-?��7¢J=44-z?—Mailing Address: 6 0 6. SA dY-J
1&0-177 Ol)r
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.)
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)
464 Sys 2 S
Mailing Address
77,
City/State/Zip
7
N
Date
(Riparian Property Owner Information) Lo 7- /
Signature
CZAC4,� r\
Print orType Name
—7 7-
Telephone Number
`7•\S•\o
Date

NC Division of Coastal Mgt. Habitat Impact Computer St-.- ,
Applicant: John Mitchell
Date: August 20, 2010
General Permit #: 56329C
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 ®
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