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❑ CAMA / ❑ DREDGE & FILL
GENERAL 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
Applicant Name
Address
City
State ZIP
Phone # ( )
Fax # ( )
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
CityZIP
Phone # (- ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
-
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No
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Permit Officer's Signature j
Issuing Date Expiration bate
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 complywith 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: 252-247-3330
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:919-733-1495
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
LARRY G ARNOLD SR 2169
DBA LG ARNOLD DOCKS & SEAWALLS 66-112/531
PH. 252-241-2636
2779 MILL CREEK RD
NEWPORT, NC 28570-6011
Y,
BRANCH BANKING AND TRUST COMPANY
1-800-BANK OBT P13T.111
17
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APA
WCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, secretary
Date 7 1 n -��
Applicant Name
Mailing Address
I certify that I have authorized (agent) a�"to act on my
behalf, for the purpose of applying for and obtainia all CAMA Permits necessary to
install or construct (activity) f do /L� � in&--4aTL 2 U 27A A (f h,
at (location)
This certification is valid thru (date) C1,4- 1
Signature /
RECEIVED
JUL 2 5 2011
DCM-MHD CITY
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper
�iD3:1CL`T RIPARIAN'PROPERTYOWNER STATEMEN T
(FOR A WERIMOORIXG FrUlyCrrSJBOA TLIFrIBOA 7HO rJSE)
I hereby certify that I own property adjacent to ,�Zt
(Name of Properly O+,ner)
property located at
4r
(Lot, Blocs, Road, etc.)
on �,.0 .,� L:iir�, �>, ..., _:�: � � in . , � 4 t , trl _ 4,•.A � N.C.
(Waterbady) Er (Town and/or County)
He has descriW to nit, as shown below, the deve:opment he is proposing at that location,
and, I have no objections to his proposal_ I understand that a pier/niooringpiiings'boatiifL'boathouse
must be set back a minimum distance of fifteen feet (iY) from my area of riparian access unless
waived by me.
l do not wish to waive the setback requirement_
I do «•ish to waive that setback requirement,
__.- -u
DESMPTION AND/OR DRANVING OF PROPOSED DEVELOPMEJNT
(To be fried in b►' fudh4dual proposing development)
riCtfy�`' �
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Printor TyneIxme
_ ti ati
Telephone Ntrmber --
RECEIVED
JUL 2 5 2011
' , DCM-MHD CITY
ADJ-tCL-., 'R �tiFARI 1 PROPERTY Q%ti'1ER*STAT£tiIE\'T
.0plicant:
C1V �
Date:
1194
J
Describe below the HABITAT disturbances for the application
found in your Habitat code sheet.
C
All values should match he name, and units of measu
HaL;!at Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
to 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
redge ❑ 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 0 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 ❑
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