61110_WALLS, BETTY PENNY_20121121

❑LAMA / ❑ DREDGE & FILL � NO. 61110
GENERAL PERMIT Previous permit #
ID New ❑Modification 7-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 I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP _
Phone # (_ )_ Fax # () Subdivision
Authorized Agent City ZIP
Affected ❑ CW C_ EW N.PTA ❑ ES ❑ PTS Phone # (_ _ ) River Basin
AEC(s): El OEA C HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: F-FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
� T
Basin, channel
cubic yards _ _
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
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:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
(Scale: ; )
See note on back regarding River Basin rules.
Permit Officer's Signature )
w
Issuing Date Expiration Date
Application Fee(s) Check # 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 (910-796-72 15) 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)

ApplicarG: f �L f6 f 4 / l
vote:
6 4-3 C&t/,,/�
Describe below the HABITAT disturbances icr ,he appiicatien. Ail values should match the nar—ne, and units cf measu� men,
found in your Habitat code sheet.
Habitat Marne
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied ter.
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 im acts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
redga Fill ElBoth ❑ Other [I
f
1
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 ❑ FM ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
.�ItBGEIi�Eb
Y
Date (Z NOV
Dclhd,�u3D CITY
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) rn L'o T)L-c kWto 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) 6 13 Ao) L,j9
This certification is valid thru (date)
Property Owner Signature
Date

a,t )
'11 ��'fi:ti'C��Ii'l�'l�ctli�t" °LiCi��l
The -3ul�llca �l ii _, d :so1�ih .i �.'-i i 1 �':.�., a 'S 1�Jll�i! i f..'' �.�li�;�%; �•`_: i.�y�')(Nrlo��; 1 t �`r'�'(�Per; c!. �1?; c:�„C;�l i
location.
I hq%ie no objection to t; his proposal. �M'MNI7crrr
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si nature
Print or type Name
My�iling Address
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City/State2ip
P. 1.-Z-
Tele hone Number
�(l9 a-)l 00'il
Date
(Ad jac Z'perty Owner I ormation)
Sig ture
Print or Type Name
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Mailin Address
Ct y/State2ip 4'��7 -3
Telephone Nu er
Date -a
(Revised 611812012)

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The applit'anl I i a: rlas ,i b—E- i tli i l 61J :j! !i✓ld+Ii i !� aI•:'`;'), s:� u' :!f '/'Li( ;l : l I I'. 2 0.1, vJa
location,
I have no obje,:ction to th lis proposal.
ACM-Mi1I?
I have objections to this proposal.
DESCRIPTION ANCIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Eivtiv I..l4 tr
//Print or %ype Name
M iting Address
City/State/Zip
19-114 1-z
Teie hone Number
T9 Gt-)i o©'i
Date
acent Q4erty Owner Information)
�eU
type Name
c;ltylstatelzlp
Tel phone ber
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Date
L_ Iv'(�
(Revised 611812012)

MOD BUCKET DREDGING INC
507 HEDRICK BLVD
MOREHEAD CITY, NC 28557-3045
6058
66-112/531
Date 11 Z 1 ) Z
cn
Pay to the e, '✓ V`J I $ -Zoo
Omer of
1 BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.00.
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FOR �'�✓—(-✓1--�— _'�.. n�
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