58150_FISH, D L_20110711

QCAMA / ❑ DREDGE & FILL
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 environmental concern pursuant to I SA NCAC �1
❑ Rules attached.
Applicant Name
Address
City
State ZIP
Phone # () Fax # ( )
Authorized Agent
El Cw ❑ EW ❑ PTA
Affected
AEC(s):
OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
D, ES ❑ PTS
J UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( 10,) , " ; i River Basin
Adj. Wtr. Body ^ ' �' gnat /man /unkn)
Closest Maj. Wtr. Body
'111m■I,P■E ■■■.a■■r�■■■■■■■■■■■■■■■■��■■■■■■■
- - ■�
. • ... - :
M.
©■■■
��«■i®w■■ii■iviii■iiii■ii�■■��iii
®�
!
ME.
�l�!■■■■■■■!!!!■!!!!!!®i�l�i!!
■■■.E■I■M■■■■f
■■■■■■
■■■■■■
Imemo!■■■■■■■
SEMEN
N
:A■■■■■■■■■MI
■moffi''■w■■n1■■■■■■■
■■■Till!■1�
i14��111�\■■■\■�!!1
■■1HMUM■■■■■■■■■■■
■R1!■lid■■■■■■■■■■il®®
■m■■i■■■■■■■■■■■■
■i��■!i■iiiiiiiiiiii!
i■■i�i�iiii�iiiii!■
ME
EN
■■■■■■■■II■■■
■■■■■■1�■■■■■■■■�;riilil���lllli■■■■■■■■
N■■
:
•
■■■■■■■■'
■■■■■■■■�■■■■■■L�■■����■�
■:
Cr!■11■■■■■■
I
■■■■■■■■■■■■■■■■■■■■mi■■■■■■+■■■■f!■■■©■M
- -
-
Nam■%
��1�■��■��■��r���l�1���H���1■l!N■■
=■��i■■■■!iilii■!■i�u�i■■�■■i!■iwii■i■�ii
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Permit Officer's Signature 1 j
It f
I
Issuing Date Expiration Date
Application Fee(s)
Check# 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 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

SAMMIE E. TURNER
MARINE CONSTRUCTION ACCT
252-725-3415
P.O. BOX 1885
MOREHEAD CITY, NC 28557
PAY
TO THE
ORDER OF
5198
66-112/531
DATE _77 - 1
�a
$ c�
BRANCH BANKING AND TRUST COMPANY
1-800-BANK 8BT BBT.com
FOR9)c
"'0000519811' l:0531011211:000521058406611'
ih
a
++,, :�
.w ` Fa.:'?:i�Y�J'�r�w:'uk'�'a�:L+��,H`.r✓�::

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to D. 1-. Fl Sty is
(Name of Property Owner)
property located at 197 PAOC)t l-IGHT 8M PRIN19-
(Lot, Block, Road, etc.)
on L 1 r-N-T 5M in 654ANT IC- Bdt, C-h4 RAT- , N.C.
(Waterbod\y) (Town an /or County)
Applicant's phone #�ii77a -%75�0- Mailing Address: 107 M0C> 1-1CiR- RIAV
7 SS16
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
D .� t-!�,.s �s
rnG�
lick
------ --------------------------------- =---------------------------------
(Informatio_u.for-Property Owner Applying (Riparian Property Owner Information)
for Perlfiit)
(Telephone
,Skor,'f-Co kef /1-�rAl(-, �/O�/
ng Address �— Signature
VY
City/Stale/Zip e/Zip Print or Type Name
Number REChone Number
i ire ate ` Date
ACM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -b • L- . F (S44 is
(Name of Property Owner)
property located at ! O 7 MHO A4 L- I ahtT 13A -1 jDR
(Lot, Block, Road, etc.)
on �MbC>N I-1GO T" BM u , in ATkh' MC- }3Cµ► C #RMF l , N.C.
(Waterbody) (Town and/or County)
Applicant's phone , V 7 Z�" 7��%Mailing Address: 1 07 M0014L14 / ' E" lD7—�'
aT—LA-1-m c. 8ciy HC
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing devllopsmeentj (�
sc
o
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
Q�C
tn� Nz�
JUL 0 5 2011
----------------------------------------DCM--M cfT-Y
(Riparian Property Owner Information)
Signature
0
Print or Type Name
Telephone Number
'7 A -/I l
Date

-- -RE
CEIvED
JUL 0 5 2011
DCM-MHD CTTY
�1 yvZ+o -4
14 •

Gull Isle Realty Rentals
Po Box sso
Atlantic Beach NC 28512
252-726-7679
Mr. & Mrs. Lee
19985 N Half Moon Dr.
Surprise AZ 85374
June 13,2011
Mr. & Mrs. Lee,
The neighbor to the right of your property at 107 Moonlight Drive wants to redo his dock the same way it is
now. He needs your signature to allow him to proceed with construction.
Call me if you have any questions.
Derek Waller
Gull Isle Realty
RECEIVED
JUL 0 5 2011
DCM-MHD CITY

Applicant: �� f
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft,
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tem im acts -
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
�redge ❑ Fill ❑ Both ❑ Other
;
Dredge ❑ Fill ❑ Both ❑ Other ❑
bredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑