58105_JOHNS, JANICE_20110817

❑CAMA / ❑ 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 15A NCAC
❑ Rules attached.
Applicant Name
Address
CityState ZIP
Phone # O Fax # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
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
OMEN
No
.
ME
was
■■■■■
NE
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ONE
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Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit"
Application Fee(s)
Check #
Issuing Date
Local Planning jurisdiction
Expiration Date
Rover File Name

A
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
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)
Revised 08/09/06

B PRESCOTT MARINE CONSTRUCTION
PO BOX 874 252-249-0149
ORIENTAL, NC 28571
PAY
TO THE
ORDER OF
First Citizens
Bank
FORS!
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CERTIFIED MAIL • RETURN RECEIPT REQU.EV-42;".
Cale ISION OF COASTAL MANAGEMENT
ADJACENT Jay),
RIPARIANPROPERTY 011UIER ��OTaFd ��aT"VINYWAN-M—C? FORDName of Property Owner: 1 _c, i 0 kn S
Address of Property:
(Lot or Street or Road, City & County)
Applicant phone* � � 5 � '�t� � � Mailing Address: ?O B Oil f5 1
I hereby certify that I own propertzi adjacent to the above referenced property. The individual
applying for this parmit has des;ms eb101d tc- me as o =:: en th' � - _� = _ �' :: g_ a development
they are proposing. A descriplion or dimensions must be provided with this letter.
/ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must nofy the DAdsion of Coastel Management
availably - - --- ,�- - --- _- - - - COAST. No
reSpol� a a8 ..,i
WAIVER SECTION
I understand that a pier, dock, mooring piling-,^IIe'^oathousti, or lift- rnust be set back a
minimum distance. Of If 37f o%:: i ty area of 3 ipana t access unit ss �.a va<: by ma. (if you wish to
waive the setbac�, you ..ivast 3rirsl 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 Information)
Signature
Tnu J c"6s
Print or lype Name
Mailing Address AAj
rn
City/Sta zip . `
252---yq5- 0�=
Telephone Number
(Riparian Propert's Owrier Information)
Si tt�� ,. e
I v% 0. %^ to \ Ca r 1 Ci Y �C' lr�
Print or Type Name
1P O
Marling Address
Cify/State/L
Telephone Number

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Janice Johns
Date: August 17, 2011
General Permit #: 58105C
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
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
HG
Dredge ❑ Fill ❑ Both ❑ Other ®
60
60
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
696
696
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 ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanagement.net revised: 02/03/10

■ 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.
1. Article Addressed to:
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• ❑ Agent
ddressee
B. Received b inted Nam C e of elivery
D. Is delivery address differdnt from item 1?/ U
If YES er�ert�U-v-erVvAdress below: ❑
VC
3 ice pe j
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❑ istered ❑ Retum R ipt for Merchandise
❑ In ed Mail ❑ BA.D.
❑ Yes
2. Article Number 7004 13 1 6 5 3 8 3 8 51
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt Q S 102595-02-M-1540 ;

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• Sender: Please print your name, address, and ZIP+4 in this box •
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zeIER: COMPLETE THIS SECTION
■ 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.
1. Article Addressed to:
00X s(il
a�srs
I
COMPLETE THIS SECTION ON DELIVERY
-A
A. Sign/tufre;, ,�
X G�J u� ❑ Agent
❑ Addressee
B. Received �me) C. Date of Delivery
D. I eliverypd s�'ifierentfrorA;hm 1? ❑ Yes
YES, enter delivery address tiel`o ❑ No
3. e re
iedjis_t Receipt for Merchandise
ured IJIa' O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 70D4 1350 0001 6538 3868
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt /z 102595-02-M-1540

UNITED STATES POSTAL SERVICE
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• Sender: Please print your name, address, and ZIP*4--invfNis box •
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BOX
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