59347_JAMES, BERTHA_20111012

❑CAMA / ❑ DREDGE & FILLt
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 15A NCAC
❑ Rules attached.
Applicant Name
Address 1:
City State ZIP
Phone # O _ Fax #
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ iH ❑ USA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: , )
Pier (dock) length
Platform(s) It I
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
-
1
I
�
cubic yards
Boat ramp
Boathouse/ Boatlift
I
Beach Bulldozing
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
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+.
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1
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See
note
on
back
regarding
River Basin
rules.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

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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
Neuse River Basin Buffer Rules
❑ Other:
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)
Revised 08/09/06

t•'iMA
NCDENR 0 P
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date / " --�2, /7 ` 2 i.) i t
ApplicantName �1 GZO'Z1�5
Mailing Address
IVL'Af
C'C
I certify that I have authorized (agent) `P;�Iylk X�' eXAISDW to act on my
behalf, for the purpose of applying for and obtaining all CAM,A Permits necessary to
install or construct (activity) GL C
at (location)11 /4 1-Ci /17't//2(Eri -4)Y,'c% , 11J /VG s6 d�
This certification is valid thru (date)
Signature L .-�-
IZ12 '7 -2C t f
i RECEIVED
OCT 1 1 2011
DCM-MHD CITY
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT IA
N� Yl�
I hereby certify that I own property adjacent to �-A 's
(Name of Property Owner)
property located at C2 % E5 — &V e�
(Lot, BIock, Road, etc.)
of
on U (V �V , in �/ �t/y �/" \ U v� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone # Mailing Address:
4P-i� , a�n-e� �Y0-
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. � / /yJ
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
RECEIVED
OCT 11 2011
DCM-MHD CITY
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
,�2f �- /zi�e-z'L l�
Mailing Address Si ature
.o
City/State/Zip Print or Type Name
Telephone Number Telephone Number
Signature 44,��, Date © Date

CERTIFIED MAIL, RETURN RECEIPT REQUESTED
o p�
DIVISION O1= CCASTAL Ta1'A�1,AGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIPICAT11ON/ViAlVER FORM
Name of lndividUal applying for Permit:
�__ t_�ej-
(Lot or Street t#, Street or Road, City & County)
I hereby certify. that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If Mora have ol7jPrtiol-Is fa:� 14/i7at is being proposers, pleas€ writs= the lil(iSiC.P7 of C:C3Se«'i
Uanagen1ent, 406CommrCcl Avenue, Morehead City, NC, 28557orcall (252) 808'-2808' within 10 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
/ n 1 WAIVER SECTION
/ 1i�L• -%,S - ,et
x" (r,- ( er-_k 0 ►'1 ► Y y DPP j n� uP 1�e.1-t,�,��
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags 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.
(Applicant Information)
j
✓� e � Cy cL Ake,
Marling Address //// ff
LAD
cit
City/State/Zip
Telephone Number
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
Date
RECEIVED
OCl 112011
DCM-MHD CITY

(�L��cli—BTER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 3. Also complete'
A. Signa M
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
X
B. Received by ( F
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.
D. Is delivery ad
tf YES, ente di
t . Article Addressed to:
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LZ75�!
2. Article Number -
(Transfer from service label)
PS Form 3811, February 2004
ION ON DELIVERY
d
—t
I
nt
,/ �■ r
;� ddressee
' Name) C. Date of Delivery
01—
srentfrom item 1? ❑ Yes
$ddress below: ❑ No
C"
N
O-
Ilk Service Type �..
Certified Mail ❑ Express Mail
❑ egistered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7a11 azla cool
Domestic Return e 0424 2239
2595-02-M-1540

UNITED ESTATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
RECENEl) Permit No. G-10
• Sender: Please print your name, address, -ZfVAfVs box •