59301_MCDANIEL, MILTON_20111201

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
[]New ❑Modification ❑Complete Reissue El 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
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1'st N P L C
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Address
City— —---------..__—.__-_ -- State ZIP
Phone # (. ) _-- _ Fax #
Authorized Agent
Affected ❑ CW ElEW ❑ PTA El ES ❑ PTS
AEC(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
roiect ocation. ounty
Street Address/ State Road/ Lot #(s)
❑ Rules attached.
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
roiect ocation. ounty
Street Address/ State Road/ Lot #(s)
❑ Rules attached.
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale: )
of
j
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
I
i
i
I
_
Shoreline Length _ I
SAV: not sure yes no
Sandbags: not sure yes no / }
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: �'. ✓ !1 i. ❑ See note on back regarding River Basin rules.
n /Notes/ Special Conditions'^
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 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, certifythatthis project is consistentwith 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/ 1-888ARCOAST
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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, secretary
Date
Applicant Dame 'X t l_ 1, t i E- - )� /k N l E-L
Mailing Address SAL\'ER_
I certify that I have authorized (agent) I k,."4 � � Z Ito act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 1-4211)" ,
at (location) 2 j �� 1'� ��S
This certification is valid thru (date)
Signatur
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

A DJACENT RIPARIAIvi PROPERTY OWNER STATEMENT
(FORA PI.EIS21,IO i.Rlli G PILI-AIGS/BOATLIFTIBOATIIOUS'.E)
I hereby certify that I own property adjacent to o � s� _(��` �� ►�;� L-._______ s
(Nacnd of Property Owner)
property located at 'z 1 _ > 4 T e 4. 1-, a
(Lot, Block, Road, etc.) --
"� S -N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: •ZS Z Z-j--q 3 7 -) Mailing Address: •Z i y 59 tie 9;),4-" 7L D
He has described to me, as shown below, the. development he is proposing at that location, and, I
have 110 ob.jedlons to his proposal. I understand that. a. pierhnooring pilings / bo�atlift / b0athOuse
must be set back a, 1-mijilnui 1 distance of fiftt;en feet (.15t) from nay area of riparian access unless
waived by me. (If you wisil to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
- _ - DESCRIPTION AND/RJR DRAWING OF PROPOSED DEVELOPMENT,
(To be filled in by individual proposing development)
. /�'('��t 1��-'Ci n''T'>i]/h..{!� �E: nw Yai� � IiZ L'c� �� '.T•1J
0L-D L,-,nL
(Information for Property Owner Applying
for Permit)
Mailing Address ' _
City/State/Zip
,ZS Z Z-o 43 7 ------
Telephone Number
SignaWre Date
(Riparian Property Owner Information)
!' l
-�_ ignature
NNO !-. 1O-NY1IA-
Print or : ype Name
_ Telephone Number
Date

ADJACENTRIPARIAN PROPERTY OWNER STATEMENT
(,FOR A PIfRI,1100RING.PIL1NfGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 4
(Nani� of Property Owner)
property located at
(Lot, Block, Road, etc.)
(Waterbody) (Town and/or County)
Applicant's phone #:25z Zy'1" 43"� Mailing Address: r)44 h Rv+3r,
IIe has desctibed t.o zne, as sIlow" below, the deveiopi-neat he is prc1p0s11'9 at that 10CMi0D, and
))avc no obkecbons to Ills proposal.. l undcrstand that. a pie3hnoori;�g pilings / bt>atlift /boathouse
nit; t be sci back a. rninlmuin distance of t3ft,-en feet (.I IV) born my arca of -Marian access unt ss
waived by me. (if you wisix to waive the setback, you must initial the appropriate blank
below.'
V/ I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:(To be filled in by individual proposing development)
Oa •4-c.0— c> - 5 },-rt c\ i nit
(information for Property Owner Applying
for Permit)
Z.) ± 5o
Mailing Address
D�L,-)- .t �t---b�- K5'
City/State/Lip
25 z.- Z -i'�_ �4 V,11-
Telephone ;umber
Signature Date
I«F��F�ccr ^»ia-„7 ovpli V�iZ�
(Riparian Property Owner Information)
Signature
~�— Print or : ype Name
Telephone Number
Date

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