57088_WILLIS, CAROL_20110216

0 CAI -WA / L-1 DREDGE & FILL
GENERAL PERMIT Previous permit#
ONew ❑Modification ❑Complete Reissue El Partial Reissue o/Iq 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
T1 Rules attached.
Applicant Name Proiect Location: County \
Address
City
Phone # ()_
Authorized Agent
Affected ❑ Cwi
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP�`'� )
Fax # (_)
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes /
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
U UG✓ r �QliRi re, AIL
Subdivision
City oc ZIP
Phone #)12 _ zQ 73 River Basin
Adj. Wtr. Body (� C r j c n gnat /man /unkn)
Closest Maj. Wtr. Body t o <
M. M.
oil
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Permit Officer's Signature
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
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/ I-888-4RCOAST
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

NC Division of Coastal Mgt. Habitat Impact Computer Sheep
Applicant: Carol Willis
Date: 2/16/11
Permit #: 57088C
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
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Open Water
Dredge ❑ Fill ❑ Both ❑ Other 0
169
169
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 ❑
252-808-2808 :: 1.888-4RCOAST :: www.nccoastaimanagement.net revised: 02/03/10

-ADJACENT RIPA.RIA-NT PROPERTY OwINER STATE]NTENT
I hereby certify thaE 7. own property adiacent to M� %�� McGzz EF3 ` 2p11
_ S
(Name of Property Owners
roper ty located at c; 4 l r C c
(Lot, Block, Road, etc.)'
Gin hoc, r Y I
Lsir,rd ��y 21"e N.L.
(Waterbody) (Town anchor County)
He has described to me as shown below. Jhe development he is propos .-g at dh' locatic:t,
d, I i''ave no objections to his prt)posa .
DESCRIPTION ANDA* DRAM INN OF PROPOSED DEVELOP_�N'I'
(To be filled in by individual proposing develapmvu)
Signature
Print or Type Narre �`-
Telepi:ane Number
Daze:

ADJACENT RIPARIAN PROPERTY ORNER STATEMENT
N„
�r
I hereby certify that I own property adjacent to d Idlia C,.I C-1
Tlame of Prope y ) yy�� ��qqqq° rt Owner p'mvc:Qii 4�L/es•�vi
propertylocated at
l I a 7� � ��,�. r3 �� r c, k f L
(Lot, Block, Road, etc.) -- ,
un A�� SCEUitJG� , in L„ S �` s 1
- - r 0,_Y\ d %'a f r t'� N. C.
(Waterbody) (Town and/or County)
"..0 He has described tom as shown below, the development he is proposiI" at that location;
and, I have no objections to his proposal.
DESCRIPTION ANDAVI DRAWING OF PROPOSED DEVELOPMEENT
(To be fzlled in by indiv.dual proposing deveio went)
_``
Print or Type Name
-- 7z S -�.5 �5
Teiephcne Sulrber .

AV& -;A-A
r NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Applicant Name ` �c,rc� - � , + � ;
Mailing .Address _ PO k" Ll3
Its Kef J Jdr— Y L 2 `6531
I certify that I have authorized (agent) ,/V1 �' �0 1 ` lC 1�1 , to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity)
at (location) (} J o h t• �,
This certification is valid thru (date)
Signature
U�
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalm'anagement.net
An Equal Oppoftunity 1 Aifirmalive Action Employer — 50% Recycled 110% Post consumer Paper

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MICHAEL OR REGINA MCGEE
HIS NCDL 2054938 HER.NCDL 4748847
110 JOHN BROOKS LANE PH. 252-728-2211
HARKERS ISLAND, NC 28531
PAY TO THE
ORDER OF-
66-7704/2531 4203
DATE , r `/
i $uu
A a:t °ae—
State Employees' Credit Union®
Morehead City, North Carolina
52
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