60189_LEWIS, QUINTON_20120503

❑CAMA / ❑ DREDGE & FILL �`,r �' ; Q�� `•
GENERAL PERMIT
E'New ❑Modification ❑IComplete Reissue ❑Partial Reissue
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`t`n n r Project Location: County
Address tt L 1 t;? Street Address/ State Road/ Lot #(s)
City i It ; r i° `''*'t'" State'. zip
Previous permit #
Date previous permit issued
Phone # ( )
Fax # ()
Subdivision
Authorized Agent
? 4i r.' Ya u,F a v�1 Cp ,+ Q
City '�, C' k. r (1 "5 � i zip
_1 �L`� '
CW
C EW ❑PTA DES OPTS
Phone # ( ) � � � a" River Basin
y "-Te (;'5�
Affected oEA
AEC(s):
❑ HHF ElIH ❑USA El N/A
#
Adj. Wtr. Body
(nat /man /unkn)
=1 PWS:
❑ FC:
r +
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body r )0,6'
Type of Project/ Activity
Scale:
Pier (dock) length r. r 11
Platf
Finger
Bulk
Boat
Othe
—
Shor
SAV:
Sand
Mor
Phot
Waivery
C' f,`c.
❑ P ) -
pier(s)
t.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on bac1
Permit Officer's Signature
permit ** Issuing Date
Expiratioh Date
ApplicationFee(s) Check# Local Plan ningJurisdiction 1 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
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/ 1-888ARCOAST
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)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 5 " 3— 62,
Name of Property
/I Owner Applying for Permit:
A✓,.c�.�c� I�Y.�J 4 S
Mailing Address:
Q
GloNc a�-5�2-s-
I certify that I have authorized (agent) 'S LAki rer-r 64-9 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) �` p,� L t� C �, Z
This certification is valid thru (date) IZ— 2-
Property 4er Signature e�� J Date