61075_HARVELL, LARRY_20121116

--CAMA / DREDGE & FILL NO. 61075
GENERAL PERMIT Previous permit #
New F7Modification r 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 { .
Rules attached.
Applicant Name r , a 1
P ' P .--s.. G .�jq. �'t I
Address � i �'
City , t <_ n ; G Stater C ZIP �7 / f 10
Phone # O Fax # ( )
Authorized Agent M, � e I a �/ J-
Affected 11 CW _i EW ❑ PTA [3ES ❑ PTS
AEC(s): F- OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
-1 Pws: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)_ _
Groin length
number
i I
Bulkhead/ Riprap length -I j K2 x
avg distance offshore
max distance offshore
_t
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
1 06
Shoreline Length
SAV: not sure
yes
©o
Sandbags: not sure
yes
Moratorium: n/a
yes
Photos:
yes
no
Waiver Attached:
yes
no
A building permit may be required by:
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision Uts
City i i tx ZIP )r,
Phone # (lei) K 10 — 1142�1 River Basin
Adj. Wtr. Body ^; 1 A, C (nat ma unkn
i
Closest Maj. Wtr. Body 1 '" c� ` 10 r
Notes/ Special Conditions
n � 1•;
j
(agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit'*
--s
(Scale: ! _ j )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature i
Issuing Date Expiration ate
ApplicationFee(s) Check# Local Planningfurisdiction 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/ 1-888ARCOAST
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)

Alfillf*A
WOENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
t Dee Freeman. Secretary
Beverly Eaves Perdue, Governor ,fames Fl. Gregson, U va ar
Date /0/ /'-
Name of Property Owner Applying for Permit:
Mailing Address:
d.� xor-/-f x/4
� .� l� J �S
I certify that I have authorized (agent) Q l L �`
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 154U 1"IT A 4
at (my property located at) L 1 S A�"�`� UL
This certification is valid thru (date)/�-
1CJ4f1iM�(..t�. � e
Owner Signature
/0- 7- / Z
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal opportunity 1 Affirmative Action Employer — 5VIo Recycled t 10% Post consumer Paper
- Lea.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to z4 K/A-/ 4tJ,0 ooA1-A11C 1* l�C s
p Name of Property Owner)
property located at # i r)K d 7q-k fIftmnwLK
(Address, Lot, Block, Road, etc.)
on inN.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informatio (Adjacent Property Owner Information)
Signature � ✓�� Signature
Print or Tyo Name ,0 Print or Type Name
0 o ff �JL�I/
Mailing Address N� O Mailing Address
Ci ya� � � � / City/State/Zip
Telephones N ymber // Telephone Number
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Date Date
(Revised 611812012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1fAA0 &AfAllC=
. (Name of Property Owner)
property located at
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's
(Address, Lot, Block, Road, etc.)
on in 9'ofzKegs .15 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
i
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informatio)lw, (Adjacent Property Owner Information)
i
Signature � � Signature
AAAPrint or Tyo Name 06 AWF 4q, Vie ' Print or Type Name
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Mailing Address AJd O Mailing Address
Ci y/State/Zip City/State/Zip
Telephone N ember• , Telephone Number
Date Date
(Revised 611812012)

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B. G. HARVELL 336-373-2271
3805 ROCK HAVEN DR 1363
GREENSBORO, NC 27410 66-7593/2531
Date jy
Pay to the
Order of -
r-A,GREENSBORO MUNICIPAL
Federal Credit Union
Greensboro, NC 27401 0 e
1: 2 S 3 1 ? S 9 3 j 1: 13 20000 2 S S0011m L363
Harland Clarke
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