57628_TAYLOR, IRY_20110908

1
❑ CAMA / C 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 I SA NCAC
Applicant Name ),e
Address 2� I?a t�eD
City State r•I C ZIP S
Phone # ( ) Fax # —)—
Authorized Agent
Affected ❑ cW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Previous permit # r
Date previous permit issued
Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s) j C) `I ICJ
Subdivision V -71
a
City( L P ( r ZIP
Phone # ( `�" River Basin
Adj. Wtr. Body r F I . ' (nat /man /unkn)
Closest Maj. Wtr. Body E'
"I ' - , .
Permit Officer's -'I-Signature (�
Issuing Date Expiration Date
Local Planning Jurisdiction 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 (252-946-648 [)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
Washington District
Mailing Address:
400 Commerce Ave
943 Washington Square Mall
1638 Mail Service Center
Morehead City, NC 28557
Washington, NC 27889
Raleigh, NC 27699-1638
252-808-2808/ 1-888-41RCOAST
252-946-6481
Location:
Fax: [phone]
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
(Serves: Beaufort, Bertie, Hertford, Hyde,
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
Tyrrell and Washington Counties)
919-733-2293
Fax: [phone]
Elizabeth City District
Wilmington District
1367 U.S. 17 South
127 Cardinal Drive Ext.
Elizabeth City, NC 27909
Wilmington, NC 28405-3845
252-264-3901
910-796-7215
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
(Serves: Brunswick, New Hanover,
Dare, Gates, Pasquotank and Perquimans
Onslow -below New River Inlet- and
Counties)
Pender Counties)
Revised 08/09/06