55307_KNISELY, DAVID AND DONNA_20110315

❑ CAMA / ❑ DREDGE & FILL
^1
GENERAL PERMIT Previous permit #
❑New El Modification ❑Complete Reissue ❑Partial Reissue ./L. 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
Applicant Name
Address
City State ZIP
Phone # (`) Fax # (.)
Authorized Agent
D Cw ❑ EW ❑ PTA
Affected
AEC(s):
El OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
I] Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision ? '
City ZIP
r'
Phone # ( ) River Basin
Adj. Wtr. Body {nat /man /unkn)
Closest Maj. Wtr. Body
i
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■■■■■■MOM
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■MEMO
■■MEMO■■®■■■■
mom
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■■■■■■■■■■■■■■■■M.
■■■■■■■■■■■■■■■�■■■
NON
�=101
.............
■■
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R:�11MORi/■■■M■■■■■■
■■■■■■■■■■■■■■■■■■■■■IL4�fil■■�IIiIG'ii4■iRlgf'■fit■■
No
MEN
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MEE
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
PermitOfficer's Signature
(i
Issuing Date Expiration Date
AA
Application Fee(s)
Check #
Local Planningjurisdiction 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
landowners).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify thatthis 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

Aapl'rcant:
Date:
(it
U H fi4nd
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
ternimpacts)
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)amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
MI
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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4, .
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIA10ORLYG PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to - IV, S s
(Name of Property Owner)
property located at l OB kMtsNQ-r 1D ttiE Sm/AKLS
(Lot, BIock, Road, etc.)
on e b-r `� "1ffe L< , in o©VN `C N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: SS-q- aa3-c�,a.3 Mailing Address: W /'�i4W-0 �i21Vb
igt�lS� w7w,1 *os Ll
1-le has described to rrie, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from m), area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
�.% I do not wish to waive MAR 9 2011
I do wish to waive that setback requirement. Ooro end Cu.
-------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
1 e'/IY
.100 ' r� �WC, x 4�' F �v� c�eK eR�s�
rn ai�s�t f-REi� To ,+ L 6Ntrpc�b DoC#� �7 vt,'�4TcrZ;
EbC�E WITH TH t50trr L! t i LU C k9t ►�►T ONE �N,©
l��((( N � i,�► t� y ' x Z,(%' tirvr� t K�:rrtys (FW&Czs) oM SoTly
�' rSib�S 'ORn~NG,"
(Information for Property Owner Applying
for Permit)
I Dh HAbN)o-r 1�12►v�-
Mailing Address
N L
City/State/Zip
(eS9)3,33-(o1o?3 or 2
Telephone Number
•-------------------------------------------------------
(Riparian Pr rty Owner Information)
Signature
I-Orint or Type Name
Z(z 2s//
Telephone Number

0

CERTIFIED M.Alt ° RETURN RECEIPT REQUESTED IMCOVED
DIVISION OF COASTAL MANAGEMENT MAR 14 2011
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlYiAlVER EORIM
i?C -MHD CTTy
Marne of Individual applying for Permit: Ito 1i—
rnf err, na rt :i'——tom 1».i r�-T 1Z i �i C 1�%f� r'�.Si�7_LV
(Lot or Street #, 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 you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call(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.
WAIVER SECTION
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m eo;zs i lip-c-& ro 9 „L,, .S tYf9 P ,oO 2)06A 44• WA-r ✓2S E_b6-e tv i f-h 130&f
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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'
I do not wish to waive the
setback requirement.
15' setback requirement.
(Applicant Information)
(Riparian Property Owner Information)
Im
Mailing Address
Signature
City/State/Zip
Print or Type Name
e�hone Number
Telephone Number
f n ffRol->r1
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Date
Date

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SWANSBORO
SWANSBORO, North Carolina
28584BQ50
3613950584 -0098
03/09/2011 [phone] 09:14:45 AM
Sales Receipt
Product Sale Unit Final
Description Qty Price Price
Product / Service Rate Inquiries
Product / Service Rate Inquiries
SWANSBORO NC 28584 $0.44
Zone-0 First -Class
Letter
0.40 oz.
Expected Delivery: Thu 03/10/11
Return Rcpt (Green Card) $2.30
Certified $2 80
Label #: 70100290000036021038
Issue PVI: �$5 54
Total:
$5.54
Postal
MAIL,. RECEIPT
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Certified Fee
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Return Receipt Fee
Here Postmark
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(Endorsement Required)
Restricted Delivery Fee
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(Endorsement Required)
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Total Postage &Fees
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