61022_JACKSON, RANDY_20121022

"LAMA / D DREDGE & FILL
N O . 61022
GENERAL PERMIT
Previous permit#
EINew ❑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
❑ Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City ----------State ZIP
Phone # ( ) _ i Fax # (__ ) _
Subdivision
Authorized Agent
City_ _ ZIP
Affected ❑ CW ❑ EW L' PTA ❑ ES PTS
Phone # ( ) River Basin
AEC(s): D OEA ; HHF L IH i UBA Ll N/A
Adj. Wtr. Body (nat /man hm"
❑ PWS: I]FC:
ORW: yes / no PNA yes / no Crit.Hab.
yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number____
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift f
Beach Bulldozing___
Other
Shoreline Length
SAV: not sure yes
no
Sandbags: not sure yes
no
I
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required by:
Notes/ Special Conditions
(Scale: ) I
_ See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit Officer's Signature
Signature ** Please read compliance statement on back of permit'*
Issuing Date
Expiration Date
-1 I
Application Fee(s)
Check # Local Planningf urisdiction
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/ 1-888-4RCOAST
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)

B PRESCOTT MARINE CONSTRUCTION 3313
PO BOX 874 252-249-0149
ORIENTAL, NC 28571 66-30/531
472
DATE
RAY TOTHE Aff-
D I }:ORDEROFOLLARS
First Citizens
Bank
r.
FOR �-k"V^L:�;�
11'00 3 3 L 3111 I:0 S 3 L00 3001:00 L 7 L 20 2049 71►'
�.r

■ Complete items 1, 2, and 3. Also complete
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.
Article Addressed to:
%/,c��l h e l C
r3ox�/83
Is delivery address different from item 11 ❑ Ye:
If YES, enter delivery address below: ❑ No
3. Service Type
OtCertified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7 011 0470 0000 7751 4 011
(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, address, -'and Zi1P+4AnT-thin box
MOM int
po
or (.en-0ji
1._. 11,111i I I I i 1 .1 1 1 1 M tf of
j :. .4 111.1111111f I I

10/13/2012 15:15 252-847-8202 PCMH PHARMACY PAGE 01/02
N.C. DIVMM OF COASTAE. MANAGEMENT
AGENT AUT'HORiZATION FORM
1 • .
I "rdfq that I have stt6or td (agent) -. &�4gNil t ( _ fa 40 or pry
bebM toe the parpw of sppiyiug for MW ObtliftingAg CAMA FemNs �ecee yrp
This mot" Iff"W thru (daft)
Dote

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to t— I S {1 b0kI ill J0 C n 's
(Name of Property Owner)
property located at �f `1y Rd
(Address, Lot, Block, Road, etc.)
j,1 v `,�
on _E I ` �iS � U e'� in �f (� Y Y ► ' ,1 QM I I C (-% (G . N.C.
(Waterbod�JY
(city/Town and/or County)
Agent's Name #: I 10 �X4 Mailing Address: PC So (
Agent's phone #: 2, ;Nq-0it,qI� I e 4�l�Cl�� � �-F -7
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)
POT
TO
Cw-ridtoe aC Sc,rn TwicH2Lt-
c,oaoj ptcpeo+ P(0VCv4y
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.nccoastaimangement-net/contact dcm.htm or by calling 1-888.4RCOAST. No
response is considered the same as no objection if you have been notilied by Certified Mail.
(Property Owner Information)
Signature
Print or Type Name
J 2 J--5 Poo csS i n 12c�
Mailing Address
City/State/Zip
Telephone Number
Date
(Ri ; n Property Owner Information)
Signature
�- Le�_
Print or Type Name
Mailing Address
City/StateOp
�y,1 C)cs2
Telephone Number
m6LZ 17� 20
Date