58801_LTG THREE, INC_20110915

• ❑CAMA / ❑ DREDGE & FILL �►.3._ C_
GENERAL PERMIT 'Previous permit#
❑New ❑Modification ❑Complete Reissue El 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 Project Location: County
Address , Street Address/ State Road/ Lot #(s)
_1 1
City----- -- - _ _---- State ZIP
Phone # (_._) _--_---__-._ Fax # ( •--
Authorized Agent
Affected ElCW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no
Subdivision
City
ZIP
❑ ES ❑ PTS Phone # ( ) River Basin
❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
Crit.Hab. yes / no Closest Maj. Wtr. Body
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Agent or Applicant Printed Name t
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer's Signature
;i
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, certifythatthis project is consistentwith 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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: �_ / b - 3 Snle
Address of Property: _ -1 1 l0 -ytt 1...-TCKC I ti 1 r I F'VX • _V11
(Lot or Street #, Street or Road, City & County)
,fie- �J57,5
Applicant phone #: c;q, 1-/da l l95'6— Mailing Address: Q dux/ 17�o
S�Z4u2 A4 AlC • a iS73-
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 roposing. A description or drawing, with dimensions, must be provided with this letter.
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I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is beingproposed, you must notify the Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 9-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.
(Prop y Ow er Information)
7
Signature
/orri 11%4101�1
Print or Type Name
Po. �K l7�
Mailing Address
34L4E P<_ P-� ti s 75
City/Sta te/Zip
Telephone Number
q-/-
Date
rian Property Owner Information)
Signature 6ecca
M&Y ors Pb ")4 �6'yo psy0c
Print or Type Name
ED 6=� st)�_-')
Maili Address
City/State/Zip
a s a -
Telephone Number
Wil
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L 1 (� , S J-71(' 's
/_ �/ Cam, ' Q 1 p ((Name of Property Owner)
property located at " / �' � `��/� ��V, 1� {:( S'- k,
(Lot, Block, Road,, entcl. `
on I J �C�l,{ , in J.� f'��4-�( A"k, N.C.
(Waterbody) (Town and/or
County)
Applicant's phone #: L-)U )2-�Mailing Address: J v 17i
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in vy proper7y owner proposing development)
WC �I' LL
Oak
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-------------------------------------------------------
(Information for Property Owner Applying
for Permit)
P C. ?,�, J 7L
Mailing Address
S�Lt�i2 ��f�1 Ak- a9S�.-
City/State/Zip
'a -�/aa
Tele hone Number
ignature Date
--------------------------------------------------------
(Riparian Property Owner Information)
0 Signature
d�zbrcc� sm %+e, Ate- Ta(�_
Print or Type Name
3514- Z-11/02-
Tele hone Number
g �
Date

• Sender: Please print your name, address, and ZIP+4 in this box •
on, Moo,
p e fox 1 �C
liiii,ik}fi}IFIFiFFitif}�}Sf i�tt

■ 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:
1 C
i �b cq /j., 46
�me�a
2. Article Number
(Transfer from service label)
A. Signgtyre ,
❑ Agent X
❑ Addressee
B. Re ed by ( me ame) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
It YES, enter delivery address below: ❑ No
3. Service Type
0 Certified Mail 0 Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
PS Form 3811, February 2004 Domestic Return Receipt 102585-02-M-1540 j

UNITrM-BV. M.
ON'S r"-f-r 01-1 P
• Sender: Please print your name, address, and ZIP+4 in this box •
-Tc) tIt A 4 5 CAI
2 SS 73-

■ 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:
Lei
ti
1 3
C 4 C >�
2. Article Number
(Transfer from service label)
A. Signature
x
❑ Agent
0 Addressee ,
B. Received by ( Printed e) C. D e ofit
Delivery
/E1
D. Is delivery address different from item 1? Yes
If YES, enter delivery address below: No
3. Service Type
❑ Certified Mail O Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M4540

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �_ l & - 3 _hl C
Address of Property: _9 7C, , A L'{',-P, P,4+k Rd' glqL46' AA /V ' (2 • ,,), K 75
(Lot or Street #, Street or Road, City & County)
Applicant phone #: c� 5 a -yob - /�% 5 J Mailing Address: _ P 0, & / 7(D
selcl, L+ee P'44_1� a. �2. a 8 75--
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 drawina_the development
they are roposing. A description or drawing, with dimensions, must be provided with this letter.
�C�
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.
�J� �` I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
r��a-yea-i9�
Telephone Number
9--/-//
Date
(Riparian Property Owner Information)
: � ��7 0AA—
Signature
�1u�Td r , BaI(el
Print or Type Name
+, /ati
132 �Cluwct In/ �
Mailing Address
1q&t h:' /V c 2 51
City/State/Zip
�5-2-?:Z&-- 8233
Telephone Number
q��ol
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(Nei (krawc 1 ool e ©W erfr4Ssocralton>
I hereby certify that/own property adjacent to
4Tg— 3 Inc, fs
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
in Cr L
ct l-(Cfet- c ce" , N.C.
(Waterbody) (Town and/or Cot
o nty) /
Applicant's phone #: �z' �22" t'�SS Mailing Address: L0
c6flUC- 2as ?.-
He has described to me, as shown below, the development he is proposing at that location, and.,47,
have no objections to h1s proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
P `�
(Information for Property Owner :applying
for Permit)
Po-�� 17(,
Mailing Address
�S L4ep- Aft Al e a k5 75-
City/State/Zip
Tele hone Number
;40-� -//
Signature Date
(Riparian Property Owner Information)
yresxwv /vlon
/ Signature
doncL/
Print or Type Name
252- %* —C>
g1317 1(
Telephone Number
Date