57193_TAYLOR, JACK_20110412

❑ CAMA / ❑ DREDGE & FILL 0' J
GENERAL PERMIT Y Pr 'o s ermit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue r'
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_
Address
City
Phone # ( )_
Authorized Agent
Affected ❑ Cw
AEC(s): ElOEA
ElPWS:
ORW: yes / no
State ZIP
Fax # (i)
❑ EW El PTA El ES ElPTS
ElHHF ElIH ElUBA El N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
evi u p
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
❑ Rules
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length X / (Scale:
Platform(s) k"r
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
`
I
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
r
Photos: yes no7T
I r .
Waiver Attached: yes no �
A building permit may be required by: El See note on back regarding River Basin rules.
Notes/ Special Conditions
s
Agent or Applicant Printed Name 1 r'
Permit Officer's Signature f
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Check #
Issuing Date
Local Planning jurisdiction
Expiration Date
Rover File Name

C
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
❑ Neuse River Basin Buffer Rules
❑ Other:
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/ 1-888-4RCOAST
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

NC Division tif Comital t- Habitat Impact Computer t
Applicant: Jack Taylor
Date: April 12, 2011
General Permit #: 57193C
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
__tem_p impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
695
695
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 ❑

ATA
own
HCDEHR
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Date A /11
Name of Property oar Applying far Permit:
TAM IQE,
Ij
A2 flicuse, eiue-r A
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l cerft 6011 Lave awftriaed (agent) Y HS(& MOM c f vc4 ion to act.. my
bek*U, for the purpose of appbiag for and Obtsbiag a! CAAvIA Peraeits wry to
Install or e(Marowt (SICAVW) Can Yr
at (►try wvp arty weaned at)
This cye Micatttos is vwW thrn (debt) _� C1—ti—I .
40a C,orrunercar Ave w, AA mtwjad City, Forth Caursfirta M7
Phone: [phone]M 1 FAX- 252.247 t I►tmlet Www.nccDaqWmvtVSmejtW
An L4U31 OPP000* l MiTr oo1k" kcrm _ M% Rat➢CW } 10% Past rOVx r pW,

ADJACEN'T RIPAR]iAN PMPnTY OWMm grAT NUgNT
I hereby certify #hat I ovum property adjacent to i s r s
(Name of fts (h"er)
lmperty located at
on P.u.Se, i Ver . in T)awL'co co , N.C.
(way) (Town =dtor Comty)
Applicant's phone#:2 ^322 �155 MWW Address:__ 1t.1'YIQ�
itxz
He has desc nbed to rue, as shown below, the development he is proposing at that kx2flon, and, I
have no objections to his pmposaL
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Mailing Address 7S iature
City/Stafie/Zip
Telephone Number
Signature Bate
Print or Type Name
Tdephone Number
=

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
IN Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
��IIeC
1�4 Cow C I A .
SECTIONCOMPLETE THIS ON DELIVERY
A. Signature
7//
❑Agent
X < ? ❑ Addressee
B. Received by (Printed Name) C. Date
to of De very
D Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Fe3vice Type
Certified Mail ❑ Express Mail
❑ Flegistered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
Y�ittti%le fluik£�T 9a 'C%�
�,(fr�nst�r-f.�o/�sesvicatabei) 7004 1350 0001 6538 3592
P$ FgL . 8 .�, ��bruary 2004 J Domestic Return Receipt `r7L� 102596o2-M-1s4o

UNITED STA-MEP ", ,,, fag
M 0C. ?6-
Ap"R.
0 Sender: Please print your name, address, and ZIP+4 in this box •
TrPs (C-ft y7-14
To �vX

AIJACUIT RIPARMN PROPERTY OVmm STATENom
I hereby certify that I own property adjacent to 's
4Na�e of PLO -
property
(lam Block Road, ems.)
2 1 Ver , is $�cc� ah o �avrI c o Q N.C.
(Waterbody) (Towa► andlor County)
Applicaat's phone #: �2,�Zz- �I`�5 g Address• :�-i v ' C6
alnoC-11
He has desm-bed to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal_
DDF—SCM ON ANlDMR DRAWING OF PROPOSM DDFVEID
(,eusc
W Ck I I
pqc H
gafOrmafmm P �
fur' PmP%V Owner
for Pftm it) g n �scsper-ty )
m� C)" a Loi e--) 2�
Man Address
Sig.n-eaft"
City/State/Zip -
Print or Type Name
Telephone Number -
Telephone Number
Side Dam
Date

B PRESCOTT MARINE CONSTRUCTION 2393
PO BOX 874 252-249-0149
ORIENTAL, NC 28571 `` 66-30/531
DATE (/ 472
PAY jA $�r}rl
TO THE
ORDER OF -
� DOLLARS � �•°„•o
First Citizens
Bank 171,13 a�
firsteitizens.com� 4a4lx,
FOR ?
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