60269_KOOS, SARAH LEE_20120823

❑CAMA / DREDGE & FILL r` No. 60269
GENERAL PERMIT Previous permit#
=iNew ❑Modification ❑Complete Reissue riPartial 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
i
FD Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City , r State ZIP
i 1 "7 --- —
Phone # () _' / Fax # (- _. )_ Subdivision
I �
�I
Authorized Agent City_—,-1 i _ZIP
Affected Cl Cw VIEW 7 PTA ES PTS Phone # River Basin
(- - } ----
--i OEA HHF IH UBA F ' N/A
AEC(s}: Adj. Wtr. Body -_ (nat /man /unkn)
Pws: FC:
Body
y
� ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. —-
Type of Project/ Activity
Pier (dock) length
Platfor
Finger
Groin I
n
Bulkhe
av
m
Basin, c
c
Boat ra
Boatho
le
Beach
Other
Shoreli
SAV:
Sandbag
Morato
Photos:
Waiver
(Scale: ) I
m(s) —�i
/
LJ
-+ ,- --
--'
-
I :r
A building permit may be required by: !� n M o
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
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:
[D Tar - Pamlico River Basin Buffer Rules ;[ Other:
D 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)

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Dates i jg , 49MT -W l a-,
Name of Property Owner Applying for Permit:
Le .s_ +K0 o s
Mailing Address:
\ ► %
I certify that I have authorized (agent)-& 61 CQt 1W)I III on my
behalf, for the purpose of applying
t for and obtaining all CAM,/APermits necessary to
W install or construct (activity) 22o n '` I-Q'r ,
at (my propertylocated at) J3-.bi Cam--9 LL&.2 Zay L.
oy- ie' if -! ► Nk AS511
This certification is valid thru (date) 9 d
74a Ld L7 CZ-IU
L p�
Property Owner Signature Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] \ Internet www.nccoastalmanagementnet
An Equal Opportunity 1 Affinnabve Ad= Employer- 50% Recycled 110% Post Consumer Paper

CERTHIED NSA,— RETURN RECEIPT REQUESTED
DrVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO'I`MCAT ONI AI'VEER
FORM
Name of individual applying for the permit:
Address of property:
u& koC/J
(Lot or street, street ofroad)
1
(City & county)
I hereby certi�� 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.
'f 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 Ave., Morehead City, NC 28557 or call [phone]
Nvithin 10 days of receipt of the notice. No response is considered the same as no
objection ifyou have been notified by Certified Mail.
Waiver See -don
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift 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.)
04
I do Irish to waive the I5' setback requirement
i do not v{is-b to waive Lhe 15' setback requirement
r �
Siva re Date
r e- Lg...
Print Name
Telephone number witb area code

CRTU< D MAIL —RE TIURN RECFIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP4RIA.lai I'I OPERi T - 4 R NO'I`MCA'I ION[WAIVER
FORM
Name of indiiv?dual applying for the permit:
Address e-:"property: t R' 9ci
(Lot or stmeOk saret of road)
I hereby certify that! 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 objeeuons to this proposal
if you have objections to what is being proposed, please write the Div&ou of Coastal
I+Ilanagement, 400 Commerce Ave., orehea�i City, I+IC 2$557 or call (252) 80$ 28flS
within 10 days of receipt of the notice. No response is considered the same as ne
objection ifyou have been noted by Certified MaR-
Waiver Section
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbag must be set back a minimum distance of IS' From my area of riparian
access unless waived by mf (If you wish to waive the setback, you mast initial the
appropriate blank below.)
.1 do wish to waive the 15' setback requirement
_ i do not v4sb to waive the 15' setback rqubremeM
)"'na" . Y= A) " 2 -:;2-- 1 1:)-
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