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❑ CAMA / ❑ DREDGE & FILL $ ' �" .... �
GENERAL PERMIT Previous permit#
❑New ❑Modification El Complete Reissue El Partial Reissue �� Date previous permit issued
3
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_
Address
City
Phone # O_
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ Pws:
ORW: yes / no
State ZIP
Fax # ( )
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
-}>< City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
—
I
max distance offshore
Basin, channel
cubic yards
Boat ramp i
Boathouse/ Boatlift
Beach Bulldozing
Other
i
_
i
i
i.
i
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no /
Photos: yes no
Waiver Attached: yes no 44
A buildingf!
permit may be required b : Y � ❑See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit**
Permit Officer's Signature 7.
Issuing Date
Expiration Date
Application Fee(s)
Check# Local PlanningJurisdiction
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:919-733-1495
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
Fax: 252-247-3330
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
C Division of Coastal N49t. Habitat Impact Computer Sheet
Applicant: Scott McCauley
Date: April 12, 2011
General Permit #: 57195C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
169
169
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 ❑
7
-8 - 08 :: 1- 8— 14C ; ' z. ara ca s alit �,. � revilsedf 02i0110
2011-04-07 11:52 PPD 9196549774 >> PPD p 1/1
OWINTI"R STATE-54L, NT
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Tpp 4 PE, /11'IS'TLIFT/& M,
cdy'.Sy lba-' I owu
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(,Lut, BWOc., Road, ev;,)
Oil
rTji%-vn andior Ownty),
Applicuafg phrmi4Z—.'-I�`�.---'
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kh"vou -'ish tit -wa9l't- D)p setbiock, You voust inifial Ihe apprt�prWe blank
I dei not wisb m" warvc
------------- -- -----
PENCkIPTION ANPIC;tt DRAWING OF PRUI-POSED DEV"YL0I"N1h,,NT-
I'To lie fillers 6, kv
(111forinabon ffi;- Property Owpie' Appl-viar
far foryn-it?
citystatezip
(Riparian Property- Owner Information I
W 104 PTI Iwo MAMP-1 MAP, 'Al
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I CiGp11011e NU14ber Number
APR-04-2011 15:31 From:DCM MIDCTY Tu:91'3195
J
1DJAG1 N-f RW ]PROPERTY OWNER S'TA.'TE N'T
(FORA PlFlt/AdQ RINGpTL.pvcsaroATLTFTIBoATHOusL)
I hcscby cc, tify that I owe, pr Ipcny adjaccrit to
(?tame of Property O n r)
property located at
(Lot, Block, Road, etc.)
;,� y -� ti :;. -ti N.C.
Vattrbady)� ! (T(wn and/or County}
A.pplicxut's phone #: 4 L` - ``°"=�aiWs� Address: � `-=�--- =�.-� � ``•- .-� -
I3e has described to me; as shown helciw, the development lie is prorx>sing at that ! cation, mid, i
have rG� nh7ec:tidns w his proposal 1 undersfand that a pier/mooring pil;aps / boat3 ft / boathouse
must be set tack a miniammn distaice of fifteen feet (t T) form my arcs of riparian ess unless
waived by mc. kiryog wish to w ve the setback, you must initial the appropri tte blank
below.)
I wish to waive
_ tg y17 to that jetback requirement-
r
�--- Y --
DESCRIPTION ANUIOft URAWI_NG OF PROPOSED DEVELOP �N'1:
(`'o ba filled' by individual proposing development)
(Ynfarmation
for Permit)
Mailing Addr
Citylstatc zip
Property Owner A,pplytng (Wparlan Property Owner ]
Telephone Nuw.
.: er
Signature - Date
GOD)
Signature
ipe Name
s Number
Date
6-d W9£Z69M6 e90:6 6I 50 AV
APR-04-2011 10:24 From:DCM MHDCTY To:919195722654 Pase:2,12
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A .pI.ER/MOORlNG.p'ILINGSBOATLIFTIBOATHOUS`.t;)
I bereby ccr ify that I own property adjacent s
(Name of Pr perty Owner)
property located at 1ACA Cc'�b9 _ -_vr-
(Lot, Block, Road, etc.)
on �aw_ So Crtrc�C- , in kvG C-��e '�G �� co , N-C.
(VVaterbody) (Town and/or County) \
Applicant's pho e#:GICA• Mailing Address:
I Ie has describcc
have do objectico
Yrnust be set (lack
waived by me -
below.)
I
I do
------------------
DESC
-----------------
(Information
for Permit)
Mailing
City/State/Zip
cok- 6n
Telenhoiae N+tm
to me, as shown below, the. development he is proposing at that location, and, I
s to his proposal. I utiderstand that a pier/mooring pilings / boatlift / boathouse
minitYtum distaorc of fifteen feet (15') from niy area of riparian access unless
f you wish to waive tale setback, you must initial the appropriate blank
wish to waive
to waive that setback requirement.
17TION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(To be filled in by individual proposing development)
Property Owner Applying
CAI -AV
�j C and V3
`t / I
---------------------------------------------------
(Riparian Property Owner Information)
x
Signature
Print or Type Name
Telephone Numbcr
Date Date
Cribbs Cove Boat Lift Authorization
I � G Kcai -(f
of a boat lift fo s C. �
Name:
print
Q"
S � natur
of Cribbs Cove, do hereby authorize installation
l
Date
APR-04-2011 15:31 From:DCht MHDCTY
To:919195722654 Paee:2,2
ADJ i.'L+'NT WF PROPERTY OWNER. STATLMENT
(FOR A PIFl?Ihfn RfNC7 PII I.NGL'gIBOATLIFTIBOATNOIISE)
I hereby cyirtify that I own pr perty adjacent to %ek�
(Natde of Property Owner)
property located at t cr 1�6 Ll.
j (Lot, Block, Road, etc.)
on w
Crcc , in _ ._c�`��"'� ._�_. r.� N.C.
(Waterbody) (Town and/or County)
Applicanf's pi, ne #: \'�;1-b*7i 'S�'a� Mailing Address:-_ A\S rS �'�C�c:�'E• roc �t - -
Ho has described to rne; as shown bel0w, the development lie is proposing at that locatim, and,1
have no o jecfi ns to his proposal_ l understand that a pier/mooring piiijigs / boat:lift / boathouse
must beset bad'a minimum distal ce of fifteen feet (15) frorn my area of riparian access unless _
waived lay rue, if ypV wisia towaive the setback, you inust initiat the appropriate blank
below.)
I do of wish to waive i
/ I
V _ I do ivish to wctivc that etbdck requirement.
DESC li"I'lON ANl)/0 t URA.WING OF PROPOSED DEVELOPMENT:
(To be}illed by individual proposi" development)
----------- —----- ---------- ----------------------------- ------------------------------------------------------
(information for Property Owner Applying ('Riparian Property Ovnier In a on)
for Permit)
1 r
Mailing A.ddres Signature
City/State/Zip I Print or Type Name
312 - (a 5b_ - O21
Tel ige Nu er --- _ Telephone Number
- - _
Signature Date Date
04/04/2011 16:57 FAX
1, m
*** ERROR TX REPORT ***
***************************
INCOMPLETE TRANSMISSION
TX/RX NO.
DESTINATION NUMBER
DESTINATION ID
ST. TIME
COMMUNICATION TIME
PAGES SENT
RESULT
no
14254587953
04/04 16:56
01'03
0
NG
, 9 Iq - 5 tZ - CA ('0 51-f
Cribbs Cove Boat Lift Authorization
I ::Invk ��]- �(: of Cribbs Cove, do hereby authorize
of a boat lift for slip C.,
Name:
� L"I
Print
Signature
Date
L'd 9L9CZ69M dZL:ZO 6L 80 AV
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Govemor James H. Gregson, Director DP.P. Fraaman far rcf�nr
Date G 4V
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) ���c`� � z� U 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) C- C � C f "Z:�5 L"— L,— Y t-
This certification is valid thru (date)
Proft&ty Owner Signature
r
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: 252-808-28081 FAX: 252-247-33301 Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 1 10% Post consumer Paper
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http://67.195.13.132/us.fl 103.mail.yahoo.com/ya/securedownload?clean=0&fid=Inbox&mi... 4/5/2011
McCAULEY INTL. PRODUCTS, LLC 0s-06 2039
SCOTT E. MCCAULEY 66-30/531
4907 S. ALSTON AVE. Lq 503
115 BACCALAUREATE BLVD Date
DURHAM NC 27713
Pay to the �N $ �;w
Order of
��, �c,�.�)• c _ Dollars
First Citizens
Bank ,/' - -
tchmens.com f�
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