60273_FISHER, ROBERT_20120821

CAMA / DREDGE & FILL
GENERAL PERMIT
❑New Modification lComplete Reissue —]Partial Reissue
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_
q, W>No. 60273
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City ; . r
`s "t State
ZIP
Phone #
Fax # ( "")"
"""
Subdivision
Authorized Agent
::
�' ' l
City _ ZIP
Affected ❑ CW
FIEW ❑ PTA ❑ ES
❑ PTS
Phone # (_ — ) River Basin
AEC(s): ❑ OEA
-i HHF ❑ IH ❑ UBA C N/A
Adj. Wtr. Body Anat /man /unkn)
❑ PWS:
❑FC:
ORW: yes / no
PNA yes / no
Crit.Hab. yes / no
Closest Maj. Wtr. Body
I Type of Project/ Activity
Pier (dock) length X
Platform(s) �x
Finger pier(s) G x Z
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatlift
Beach Bull dpzing
Other
Shoreline Length
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:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
(Scale: )
_. See note on back regarding River Basin rules.
PermitOfficer;s Signature
Issuing Date Expiration Date
Application Fee(s) Check # 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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑I 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
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/ 1-888ARCOAST
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)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) � � RE-c-I T'r- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) --T>, G 4t-
at (my property located at) tCc 2—
This certification is valid thru (date)
3
Property OwneeSignature I f Date

DIVISION OF COASTAL. luiANAGEiviEN T
ADJACENT RIPARIAN PROPERTY O ,JNER NOTIFICATION FORM
CEMTIFIED WAIL - RETURN RECEIPT REQUESTED
i hereby certify that I own property adjacent to g, t, e-,� �,' 4 %, ,'s
C , (Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on jj p
ru'dater-body) (City/Tovvn acid/or County)
Agent's Name #: Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development roust fill in description below or attach a site drawing)
Ifyou have objections to what is being proposed, you must notify the Division of Coastal Management
(DCivi) in Writing Within 10 days of receipt of this notice. Contact information for DCM offices is
available at v t4w.nccoas.aiiriangemeni.net/contact dcm.him or by calling 1-888-4RCOAST. No
response is considered file same as no objection if you have been noted by Cerri— ied Mail.
�s,J a /9- / �7 /�", ram/
oevner formation) (Fri Pr�periy 04 per Information)
�Ignature Signature ,
(_Z, I U /C71k.
Print or Type Name
Mailing Address
CiIWStateJZip
��f J L1�
Telephone Number
76/ia
Date
Print or T111pe ,dame
Mailing Address (s
7
CitWStaterZip
2-6?_ -- � �3 - 61,�
Telephone Number
Date '

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to PIC16e-- Ka-eIs
property located at it (2- (!�Z oei
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on %��,�U� , in New t �c,A,� , N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
G'
VA
0 - ►�
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net(contact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
lO f" 4,1 i''fI o" A-e oO f /" L `%
(P-Tnp&Ay Owner Information) ( Property Ovyner Information)
z� i
Signature Signature L
Print or Type Name Print or Type Name
120 Z 6 �� ��f 4L,
Mailing Address "
642.4-,, E A) C-
City/StatelZip
Telephone Number
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Date
Mailing Address
City/State/Zip
252- - G 33 - C�( `f g
Telephone Number
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Date

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545 ALLIGNrOR LOOP RD 252-745-7135
MERRn, N.C, 28556 66-30/4537
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Date
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