61104_LINDSAY, DAVID JR_20121109

1-1CAMA / ❑ DREDGE & FILL P'0-6 NO. 61104
GENERAL PERMIT Previous permit#
'New ❑Modification ❑Complete Reissue [-]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 I SA NCAC
_ ❑ Rules attached.
Applicant Name _ ^�r��; t Project Location: County
A. Address fir. �:..1 '' r Street Address/ State Road/ Lot #(s)
City '�`.( 1 r _t� State iA ZIP /
Phone # (^.� "� f:_. ,ax # (�)^ Subdivision
_I _
Authorized Agent i ;+, _/ 9) City - ZIP
Affected _ CW ❑ EW I❑ PTA ❑ ES ❑ PTS Phone # () _ _ River Basin
AEC(s): Li OEA HHF ❑ IH ❑ UBA El N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
—i
if >-
i
Platform(s) ,
/ � >T
Finger pier(s)
— - --
-
-
Groin length -
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
L
I
}.
I I
cubic yards _
Boat ramp
Boathouse/ Boatlift
)
Beach Bulldozing
-
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no i .,
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
y
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
(Scale: )
M=
[I See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s)
Check# 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, certifythat 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 howto complywith 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)

�.ppltcant:
Describe below the HABITAT disturbances for the application. All values should match the name, and unitszMeaSu
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
I TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/er temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
ternimpacts)
FINAL Feat
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
In
edge ❑ Fill ❑ Both ❑ Other
/
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
,. I-<3 3. •c>t?COA::'s T ,. u?r+i tr.;iir__• ! z� s y .,.rrrsa,�.,..aj. n:at

OUTER BANKS MARONE CONSTRUCTION, INC
1501 FIRST AVE
MOREHEAD CITY, NC 28557
[phone]
.-.a.nw.n�.w,•wnmeez�+;�+.'�o�ePoe+1i06;'��7w'rCA!.��m
FIRST CITIZENS BANK
5052
66-30/531
137
11/3/2012
PAY TO THE r-
O DER OF D.E.N.R. $ **200.00 W
m
v
0
_ Two Hundred and 00/100*********************************************************
DOLLARS u
D.E.N.R. /?
MEMO
II'00 S0 5 2u■ 1:0 5 3 100 3001:00 13 1 2 18 2 ?II■
UAUThiOR[ZED SIGNATURE
OUTER BANKS MARINE CONSTRUCTION, INC
D.E.N.R.
First citizens
s
11/3/2012
5052
200.00
200.00

OUVMBANKS AV
ISM M32 des MovW6md Cyr HC 28557 DDCKS - SEA1f MLLS - ACMUmG cKa(y5
24¢2525 Dealferrar Me der
C) I. �
RECEIVED
I
Nov Q 5 Z012
ACM-MHD CITY i 5
►� �, 2sla

ADJACENT RIPARIAN PROPERTY OWNER rSTATEMENT
J I hereby certify that I own property adjacent to -ci C) -t�% �r"1 's
(Name of Property Ow)her)
property located at _ Z �� CcAV► -D -0
(Address, Lot, Block,, Rooaq, etc.)
on ?5kQcnO 02 , in L-�b \-� `a j- �-t , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
t. I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
RECOWD
NOV 05201?_
DCM-MHD CITY
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, Owner Informa
tion)U L1�
Signature
Print� Type,Namee,, w , )
Matl. g Address
Citylstat izip
_ �rz- 2--11
Telephone Number
i)Z E
(Adjacent Property Owner Information)
Signature,
Paint or Type Narpe t
1 ')S� FIB
Mpiling Address
,
ClS�-lZp,1��T
C �F
Telephone Number
1 c — 3 � -
Date
(Revised 61181207z)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
it
Date �' � , C. E ,R '
Name of Property Owner Applying for Permit:
i
/-)e'!V � / ;j1 CSC.t! �
Mailing Address:
12-� � r
RECEIVED
DCM-mm
I certify that I have authorized (agent )�rn �m 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)
41
This certification is valid thru (date) U,
Property Owner Signature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T)c,yiQ L}y -y v —1 's
l ( me of Property Owner)
property located at 12� l ��2 ���
�2�� (Address, Lot, Block, Road,etc.)
on , in N.C.
(Waterbody) (Ci /Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to a ion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
RECEIVED
NOV 0 5 2012
DCM.Mn CITY
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.
(Prope ; ormation)�U LT>
Signatz¢re
2,zf !s ) J ol, LPn*�: L
J'n T e Name /' l
Mailiv Address
City/Sty t�Zlp'
iU1
Telephone Number
2-
Date
(Ad' ent Property ner Informtio) �,�,] 1I
�ature
e
Tint or Type Name
31te +mI d4
Mai ing Address
o C
City/Sta e/Zip
a.5a- 3,-1-0q0g
Telephone Number
Date
(Revised 6/18/207Z)