53326_NASISSE, MARK_20090320

❑CAMA / J DREDGE & FILL 3 Z3"USyS�
GENERAL PERMIT 4�9 Previous permit
❑New ❑Modification El 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
Address
City
State ZIP
Phone # O
Fax # O
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ElOEA
❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County_
Street Address/ State Road/ Lot #(s)
Subdivision_
City
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
River Basin
(nat /man_ /unkn)
Type of Project/ Activity
(Scale:
)
Pier (dock) length
Platt
Finger
Groi
n length
number
ramp
house/ Boatlift
r
eline Length
not sure yes no
n/a yes no
os: yes no
head/ Riprap length_
avg distance offshore
max distance offshore
channel
cubic yards
-
i
- - - - --- -- _.._. r..�, __ . � - - -- -_ •_ i � - -�-
— -
h Bulldozing
- - '--=-
---------__---j--_-_-- _--
not sure yes no
- - — ----- ----- - -
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Exp tion Date
Local Planninslurisdiciion Rover File Name
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Exp tion Date
Local Planninslurisdiciion 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

FEB-1172009 WED 08:01 AM FAX NO, P. Ol
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F, Easley, Gevernor James H. Gregson, Director UJiliiam G. Ross Jr., Secretary
Hate 11- .2 Y--a it
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) �Q� ,tnle, f to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 0( it,
1�
at (my property located at) (p (2 W N a%� �� •~'"�'
This certification is valid thru (date)
Property Owner Signature
Date
400 Commerce Avenue, More'nead City, North Caro!ina 28557
Phone: [phone] FAX: [phone] internet: www.nccoastalmanagement.net
An Equal Opportuntty 1 Affirmative Acton Employer— 50% Recycled 1 i 6°/n Post Consumer Paper

FEB-11-2009 WED 08:02 AN
FAX NO. P. 02
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to
(Name of Property Owner)
property located at � - i''�c1/Cz^���� �/ "Ve-
-- -'
(Lot, Block, Road, etc.) /1
an
(Waterbody) (Town and/or County)
Applicant's phone #: 13t- 3 I`f -57/f-1 Mailing Address: 1IAL2�- ao - G�
s
He has described to me, as shown below, the development he is proposing at that location, ard, I
have no objections to his proposal.
------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
6C-v,:�20� ' Cyr i2�r
1
I3- ----------------------------
(Information for Property Owner Applying (Riparian Property Owner Informatio
for Permit)
Mailing Address
n,
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City/State/Zip
Telephone Number
sq7u,atlire Date
?rint or Type Name
y 99 9
Telephone Number
a g6
Ca.e

FEB-11-2009 WED 08:03 AM
FAX NO, P. 03
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
n k t5 �,
hereby certify that I c�,vn property adjacent to ,
�L, Nam_— otPropertyme of Owner -
property located at 21- rK ° D, ; VL
(Lot, Block, Road, etc.) �l
N.C.
on in (Waterbody) (Town and)'or County}
one # i�' i� u . �r �t oti G�
Applicant's ph . ?fit' l _ (5 Mailing Address: 0 —
CP
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 he filled in by property owner proposing development) j
l �J � •. — � S�b�i
i
f
Ile-
_ 130l----------------------------------------------------------
---------------------- --
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
_
(�M��;aaiillii 1nnggg Address
co K.,f—
CitylState/Zip
Telephone Number
j at
. . L�`
ti .;nature Dace
Signature
CS0VJ UN
Print or Type Name
2S-2.214q-9t02
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MUD BUCKET DREDGING, INC.
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557
PAY
TO THE G n E
ORDER OF
DATE '3' ZO 6�)
3626
66-112/531
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$ 2 00
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1-800-BANKBBT BBT.c0m
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