59775_THOMPSON, GAY_20120305

❑ CAMA / ❑ DREDGE & FILL
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 15A NCAC
❑ Rules attached.
I �' Project Location: County
Applicant Name '�.� ? i` � jA.;;.. ��r � l
Address Street Address/ State Road/ Lot #(s)
City State # —ZIP�'t: i r
Phone # (�) Fax # (f _ Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): LJ OEA E. HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Mal. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length, :;
Platform(s). , 0, I . I
Finger piers)
Groin length
numberIF
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp tt
Boathouse/ Boatlift S
Beach Bulldozing
Other—
Shoreline Length 1
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no�
Waiver Attached: yes n�
A building permit may be required
Notes/ Special Conditions
i
I
k
-
'
i
I
I
r i
by:
r^
,y
y
❑ See note
on back
regarding
River Basin
rules.
y
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local PianningJurisdiction 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:[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)
Revised 08/09/06

NRR-01-2012 16:41 From:Future Homes 9193634044 To:12522473330 Page:1,'1
March 1, 2012
Fax Memo to: Brad Connell
Fax Number: 252-247-3330
1, Gay W. Thompson authorize my agent, Alan G. Bailey with Bluewater Marine
Construction, hic., to apply for and obtain permits to repair my dock at 262
Oakleaf Drive, Pine Knoll Shores, NC.
At. �
G W. Thompsofi, Owner
k

H-
r
il
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
3-1- i z AM GHDI-hOG
ZIOZ 9 0 011dN1
Name of Property Owner Applying for Permit: C(MAiM U
Mailing Address:
/vd A- u 1 yo 2
( 'olcls da-o IV- e , i? ] S-3 3 —
I certify that I have authorized (agent) /r qeG ,,ve to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /re,Da;./` Zi4eiye /)4tt � /c> 464le
at (my property located at) 2 3 6 C>,4 ea.�L 40. Ae
This certification is valid thru (date)
Property OAfner Signature
�--?o-/Z
Date