60278_WILERSON, KENNETH_20120802

DCAMA / []DREDGE & FILL
G5NERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑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
�5 No. 60278
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City
t
State ZIP
Phone # (_ )
! Fax # ( )
Subdivision
Authorized Agent
City _ __ _ ZIP
Affected Cw
❑ EW
❑ PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
❑ OEA
AEC(s):
HHF
El IH ❑ UBA I N/A
Adj. Wtr. Body �� 1` f'e3 ` "` (nat /man /unkn)
_i PWS:
❑FC:
Closest Maj. Wtr. Body UCH
ORW: yes / no
PNA
yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathous9/ Boatlift
Beach Bulldozing
Other f )
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: f Y
Notes/ Special Conditions
Agent ar�\ppliit(Printed Name
Signature ** Please read compliance statement on back of permit **
� ur
(Scale: 1 —� )
IJ .)ee note on back regarding Kiver basin rules.
Permit Officer's Signature
p
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 (252-946-6481) 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/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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)

2012-Jan-20 10:02 AM Progress Energy 9195462684
Authorized Agent Consent Agreement
I n f; ��N�'r� a _, hereby authorize ams(-A Plain C cmcm+• to act on
(Property Owner) (Authorized Agent)
-my behalf in obtaining CAMA permits for the location listed below. This agency
authorization is lirnited to the specific activhies described above.
Property Address:
eve al 1�IM7f
Property Owner's Mailing Address and Phone Number:
,n+ Hills, Li
Property Owner's Sign
Authorized Agent Signature:
Date:
Farm: Authorized Arent Agreement as developed by NCDCM revised 7.129109

!ni
'o
LnIa OFFICIAL
r- Postage $ �j( �I Lf— aCJO
p Certified Fee
C3 (End Return R ece'O RequirFee ed) PoHsterrrie ric
O
Restricted Delivery Fee
O (Endorsement Required)
i
C`-
{ Total Postage & Fees
J !�
PS Form 3800, August 2006 See Reverse for Instructions

Certified Mail Provides: +
■ A mailing receipt
a A unique identifier for your mailpiece . ]
a A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First -Class Maile or Priority Maile.
a Certified Mail is not available for any class of international mail.
a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
i
a For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is
required.
■ For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the f
endorsement "Restricted Delivery".
i
a If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
PS Form 3800, August 2006 (Reverse) PSN 7530.02.000-9047

■ Complete items 1, 2, and 3. Also complete
if6m 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you. g,
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
gu"-")-
0
2�0
❑ Agent
❑ Addressee
by ( Printed Name)
Is delivery address different from item 1? U Ye:
If YES, enter delivery address below: ❑ No
3. �Serv,,ice Type
,9f ` Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7011 0470 0000 7751 0662
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt L C O� 102595-02-M-1540
��l F—C -

UNITED STATES POSTAL SERVICE
3L:'..L'_
Ic"lArio
• Sender: Please print your name, address,
?0 -wx- 0-�4
0I21�?-r>TR L, Nc235-qI
11 It I fit 111 l It if if 11111I IIIIl I I III Jill I I fill I III 11111111111i It

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: (✓y� 1 � � -(. 4 !) g . � l � �
C
Address of Property: 3(C 51c(C V- f (A4`
(Lot or Street #,�Sttreet or Road, City & County) '), 7
Applicant phone #: % �? _ Z �� � C)E 7 Mailing Address: It f X /
IJK- Z �'SH /
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
_ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangementneecontact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
L,O c _ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signature
41
�lwy:4J-) /() f 1 '01- /�
Print or Type Name
Mailing Address
A'L-2 %/ /VC-
CitylState&io
Telephone Number
Date
Signature
I (, 11,It, C.
Print or Type Name
03`i �31�zc b �����<� �z-
Mailing Address
City/State2ip
(-)-�;-)&�,-'-/�%17'`%
elephone Number
%..Z/t %1-,)v l l
Date

CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner.
Address of Property: I D 3(r -Nac D nia-
(Lot or Street #, Street or Road, City & County)
_
Applicant phone #: .1 �`� Ot�Mailing Address: pv &X '971
2-F-54�
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
IX I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangementnet/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 seAack, 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
h /Oi1k'r
Print or Type Name
/ (CR- ? 1-'oo-r M / /s 6-)
Mailing Address
A c/h� da1e,N
CitylState&ip
Telephone Number
(Riparian Pro erty Owner Information)
Signature
1,5f,
F1,1
Print or Type Name
7 zq S -cam r<f \N J t
Cad.
Mailing Address
C
COIState/Zip
7fJ'�-6��-y�'z4'-
Telephone Number
1 Z-
Date Date

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B PRESCOTT MARINE CONSTRUCTION
PO BOX 874 252-249-0149
ORIENTAL, NC 28571
PAY
TO THE
ORDER OF V
hopd red ob (/I
3145
DATE 472
66-301531
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First Citizens
Bank
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