57894_WEBB, MIKE_20110414

❑CAMA / ❑ DREDGE & FILL �a
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natu I Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name
Address
City State ZIP
Phone # () Fax # ( )
Authorized Agent
Affected 0 CW EEW ❑ PTA
AEC(s): a 0EA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (� } River Basin
Adj. Wtr. Body Inat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Permit Officer's Signature i
Signature Please read compliance statement on back of permit **
Issuing Date Expiration Date
Application Fee(s) Check # Local Planningf urisdiction 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
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

V v \
Date:
I D7S'/-YC
I
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.
1, replied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact a unt)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
ternimpacts)amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
lDredge ❑ Fill Both ❑ Other El
—
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

q
Nor h 11]aroiinta Department of Eryvironment and H atura! Resources
Nlichze! F. cas!e:y, Governor
Ghades S. Jones, Dirvotor William G, Ross Jr., Secret,,,/
Applicant Name
Mailing Address
I"A N C_ �gS�
I certify that I have Rut)noa-izecl (agent) Ob to auci on jn-Y
behalf, for tine purpose e.I applying for and obtaining all CAlYIA Permits necessary to
l.L
install or construct (acti,vits) ------
at (jo cation)
This certification is va}srl tinrrn (date)
11
'Signaature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I ' l t 's
(Name of Property Owner)
property located at
l � 5 m \ 1 ii 5,T
(Lot, Block, Road, etc.)
qo
d
on ,( 10 V`r�f'cr1S- , -nC- ij' cq4 , CN.C. '
(Waterbody) 1 (Town and/or County)
Applicant's phone�� l q 6 y v Mailing Address: 5'('61 1 t i �,�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
for Permit)
Q--o p-kL
5T)4�
- ------------------------------------- - - - - ---
n for Property Owner Applying (Riparian Property Owner kf 1`mation)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
Signature
�i�m-� S�"P63]-->
Print or Type Name
(4:2
0� / 2�' Telephone Number
Date

Apr 05 11 11:27a . Pam Webb
252-247-5441 p.2
A-W , CENT RRMZMN PROPERTY OWN. %R STAT"'UNT
'S
I hereby c.: tify that I own property adjacent W Owner
(Name oi' property )
9A�
,,.,� _ �
Property locate aL r.+�i a (Lot, imock, i Road, etc.) ��
'2r
(Town an'31 or County)
Vaterbody)
Applicant's p; Se"Mailing Address:-
�j
Sim
Ile has descrih : i to me, as shown below, the development he is proposing at that location, and, I
have no object i . ns to his proposal.
DES( 1 'JPTION AND/OR DRAWING OF PROPOSID DEVELOPMENT:
(To beJWed in AWOPenY ownerPropasing "vejopment)
c-7
-------� .ate+
(into 'on : it Property Owner Applying
for Permit)
Mailing Addre : ;
a&vn-h(�' �3&tc=h,
City/State,/Zip ZS
Telephone NU) ber
Z'oo,
Signature Dade
(Riparian Pro erty ner In£ormattiian)
Signature
nee cSGWL-�-s
Print or Type Name
Ll 75 �493
Telephone Number
X rr (� 02©ll
Date

SAMMIE E. TURNER
MARINE CONSTRUCTION ACCT
252-725-3415
P.O. BOX 1885
MOREHEAD CITY, NC 28557
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