61132_LEWIS, QUINTON_20121207

CAMA / Fi DREDGE & FILL F"'6 NO. 61132,
GENERAL PERMIT Previous permit#
New ❑Modification JComplete Reissue ^iPartial 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 1 SA NCAC
Rules attached.
Applicant Name I,_, o A ,r�� t 1 Project Location: County
Address I `' jJr Street Address/ State Road/ Lot #(s)
City c ,; ^ 'r-i c' State �, �� ZIP
Phone # (} Fax # (u) Subdivision
Authorized Agent 11 cY-in.3 E' 0,Vyf0City_ ! •~ ar.,.,^• -�;, r ZIP_
y n i ,
Affected CW EW PTA ©ES ❑ PTS Phone # (_____) �. > - ; l .7 2 River Basin T
AEC(s}: El OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat (man /unkn)
ElPWS: ElFC: i
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(!)_ �f
Finger pier(s)
Groin length -- ---�--
number
Bulkhead/ Riprap len h
avg distance offshore
max distance offshore
Basin, channel ----- -'--
i
cubic yards -
Boat ramp - —
Boathouse/ Boatlift -- -
Beach Bulldozing
Other
�•� it � i �_
1__{ } . . I
Shoreline Length )1 0
SAV: not sure no
Sandbags: not sure yesid
Moratorium: n/a yes `no I -7-
Photos: yes no
Waiver Attached: yes no _ I
A building permit may be required by:
Notes/ Special Conditions
or Applicant Printed Name
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
(Scale: i )
t'
See note on back regarding River Basin rules.
Permit Officer's Signature
{ t �51& I ' L
Issuing Date Expirati h ate
i
Local Plan ningJurisdiction
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:
❑ 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)

ISLAND MARINE CONSTRUCTION LLC
1286 ISLAND RD
HARKERS ISLAND, NC 28531
PHONE: [phone]
DATE f' s / bl
PAY
TO THE A
ORDER OF NC 9
WACHOVIA
Wachovia Bank, N.A.
wachovia.com
13
11800 i8 2 211' l:0 5 3000 2 191: 20000 2 17 2933911
:r
C
1822
66-21 /530
BRANCH 77513
fJ ® 6
DOLLARS �k
fw

Dec 04 12 10:47a Thomas Lawrence 252 728 3419 p.2
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
0
C T
I certify that I have authorized (agent); ��J '�/(.�:`•� r_ C to act on my
behalf, for the purpose of applying f'or and obtaining all CAMA Permits necessary to
install or construct (activity)
s,
at (my property located at) t-
r4
This certification is valid Yhru (date)
Proper`ZVv-ner Signature
Date

Dec 04 12 10;47a Thomas Lawrence 252 728 3419 p.3
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to �!,i' �7J�� i f�% (J� , �j S s
Property located at (N ot)Ptoperty Owner}
m
on Z f r (Address, Lot, Block, Road, tp.
in ��;t ' C i' � --s) C N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
i have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individualProposingdevelopmentmustfill in description below or attach a site drawing)
Oki ��in�tiC�L1 �•�
] LI r l
{� )f C�% )IVj
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.)
do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Info rr tlon) (Adjacent Property Owner Information)
n . i nalu e
S L�
Telephone
Date
Print o�Typ�a
J
Mailing
city tate/Zip.
_ 41
Telephone er,
Date
(Revised 611812012)

Dec 04 12 10:48a Thomas Lawrence 252 728 3419 p.4
I hereby certify that I own property adjacent to (;/ ;1,� % /0 J s
property located at / z�(n' �e1�Y Owner}
i
-- �-,-, (Address, Lot,
,Block
�oad, tc
IL in .
'bN.C.on , t 't
(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below; the development proposed at the above
location
I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below orattach a site drawing)
7- C 0_
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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 Ow r� Information) ( "ace t Property Owner Information)
st .S'igna t ur -
Print o �e W�r / �� Print o���y�pe Na e
Mailing ddress r� ,,per- +vim Nailin dd
City/Sterna. City/State/Zip , r�
L J �. ( i, �� _ �. i L. 12-
Telephone Number _ Telephone Number
,41011 AV
Date Bute
(Revised 611812012)