58869_LEVEL HEADED INVESTMENTS_20110921

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�-'CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New -IModification []Complete Reissue LJPartial 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
❑ Rules attached.
Applicant Name''' M Project Location: County
Address Street Address/ State Road/ Lot #(s)
City-- -- State ZIP 7u� ; ----- ►�G tt I. c.r _-
Phone # () Fax # ( ) Subdivision Na143ov\
Authorized Agent City a Lf,r e , ZIP `Ct Vi
Affected L' CW EW Cj PTA ❑ ES LJ PTS Phone # O River Basin7fia lF K
AEC(s): OEA HHF ❑ IH ❑ UBA ; N/A Adj. Wtr. Body �.� ., nat man Junkn
❑ PWS: � AFC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body-___
Type of Project/ Activity
RECEIVED
(Scale:
Pier (dock) length
Platfo
Groin
Boat
Othe
Shore
SAV:
Sand
Phot
Waiver Attached. yes no
A building permit may be required by:
Notes/ Special Conditions
-
'
F See
note
on back regarding
River Basin
rules.
1
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rm(s)
Agent or Applicant Printed Name
PermitOfficer's Signature
Signature ** Please read compliance statement on back of permit
Issuing Date
Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name

19
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
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

RECEIVED
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
sEP 13 zo>>
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER:FORM
Name of Property Owner: -�U C C_L_km �,—
Address of Property:
(Lot or Street#, Street or Road, City & County)
Applicant phone #: t3 - LA'�--1 a Mailing Address:
C , 295 q'I-
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, must be provided with this letter.
V 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 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact-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.
I do not wish to waive the 15' setback requirement.
(Prolyrty Owner Information)
Signature
Print or Type Name
d �n DIJMGCS'
Mailing Address
"iroaR4 ell
CitylState/Zip as
_Z4-olpp�� _'
Telephone Number
9-b-P
Dale
(Rip an PropToyOwner Information)
Signature
`•� e- 'Slo cure l r
Print or Type Name
10 t`7v Sc���� �tl` Lis- t�► Cieel�-
Mailing Address �—
ZSHAB
CitylStatelZip
Telephone Number
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED �cjDCJTI'
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: e- �l� e*.k-'- •- Q n /
Address of Property. k S a- az" %S `�
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 8Z8 — 13 + I Mailing Address:
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, must be provided with this letter_
_1/ I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you mustnotify the Division of coastal Management
(DCM) in writing within 10 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/st to ip
j/ G' '-47C'
Telephone Number
Date
(Riparian Property Owner Information)
L O
Signatt e
Print or Type Name
l 0 1 Sou rL. V- C2e b K-
Mailing Address
L4E- N c e s, - i �C_ 28 H$
City/State/Zip
Telephone Number
Date