58325_WINTEMBERG, ROBERT_20110824

L7CAMA9/ ❑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 I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address
City
State ZIP
Phone # ( )
Fax # O
Authorized Agent
Affected El CW
❑ EW ❑ PTA ❑ ES I] PTS
AEC(s): o OEA
❑ HHF D IH D UBA O N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab, yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # {) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
PermitOfficer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # Local PlanningJurisdiction 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/ 1-886-4RCOAST
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

TR PRESCOTT MARINE CONSTRUCTION LLC
545 ALLIGATOR LOOP RG 252-745-7135
MERRITT, NC 28556
Pay to the
Order of
04-08 0868
66-30/531
471
Date
TV
ollars
®First Citizens Bank
For
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AUIG-2-2011 10:35A FROM:
TO:912018049514 F.5
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freernan, Secretary
Date _ .� c� �� s 3 :2 o i/
Name ofPropertyOwner Applying for /Permit:
Mailing Address:
1/7
�J
I certify that I have authorized (agent) —7-6 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Perinits necessary to
install or construct (activity) & )C C 7, /f Qe &,9T u�^ ,
at (my property located at) .1 ` 3
This certification is valid thru (date) /a - 3 / 'y & //
Property Owder Signature \, Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone; 252-808-28081 FAX; 252-247-33301 Internet: www.nccoastaimanagement.net
An Equal opportunity 1 Affirmative Action Employer - 60% Recycled 110% Post consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -R06'ef W i ryfoi berg -s
(Name of Property O er)
property located at j-o..� q DAveA
(Lot, Alock, Road, etc.)
on .2 f=,D + C? ref-k Jn �A M Lo �Ot.t/> y , N.C.
(Waterbody) (Town and/or C nty)
Applicant's phone #: a01 - CM00 41A3 Mailing Address: i9 1Et-Xb00h tAJ
P-W!�IJoo A, tLT o745(o
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
.""l.lur lIVIN A114.0iLPA UnitvYlrvlz Vt+ rAVrVzV11J llL Vae,LVt rY1LrV I;
(To be fill \ in by property owner proposing development) lP-v,iect ar,s
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(Inform attoor Property Owner Applying
for Permit)
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Mailing Address
_R�,,3ett,Jood tjS o ►A5 to
City/State/Zip
:Teleph e Nu r bex
Si nature Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
Date

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■ Complete items 1, 2, and 3. Also complete A. Sign e
j item 4 if Restricted Delivery is desired.
'I ■ PriAt your name and address on the reverse X f
so that we can return the card to you. hf7ceived by (P intE
` ■ Attach this card to the back of the rriailpiece,
- ; or on the front if space permits.
1. Article Addressed to:
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❑ Agent
❑ Addre
Name) %`� C.
D. Is delivery address diff6ent from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Servi Type
emfied Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7008 0150 0003 6074 3673
(Transfer from service label)
}io2595 o2-M-t5a0
PS Form 3811, February 2004 Domestic Return Receipt

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
/VlrT I1�C�Nn,e
A. Si ature
,-k C
❑Agent
X /
❑ Addressee s
B. Received by (Printed Name)
C. D44 of D livery i
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D. Is delivery address different from item 1?
0 Yes
If YES, enter delivery address below:
❑ No
Service
3. vice Type
Mail ❑ Express Mail
❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) O Yes
2. Article Number 7008 0150 0003 6074 3680
(Transfer from service fabe!) "v-
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 i

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
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