54319_PFAFF, WILMA_20090717

0 CAMA / D DREDGE & FILL
PENERAL PERMIT
L�New ElModification ElComplete Reissue E Partial 'i sue
Previous permit #
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 -70 . i 101) 4 12ZO
Rules attached
Applicant Name
Address
City V., I srh N f e.
Stated 0, ZIP
Phone # T
Fax #
Authorized Agent ;.gn!
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PTA S 0 PTS
AEC(s): LJ OEA LJ HHF
LJ lH El UBA El N/A
El PWS:
El FC:
ORW: yes / no PNIA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
1 QC
I k'ltl�
Subdivision
City -- ZIP
Phone # -7 2. 1- 71 -1-- River Basin
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� k.-n—t or Applicant Printed Name
Signature Please read compliance statement on back of permit
Lo It �
Application Fee(s) Check #
Perm'ititiffic,er'sSig ature
--?h-46 -, 11 If
IssuinjDa Expiraticlii Date
pr gy -4
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)
Revised 08/09/06

JAN-22-2008 16:08 From:DCM MHD 2522,173330 To:252 393 8660 P.1/1
Aja
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date
%- Oi
Applicant.Name
Mailing Address
(/t4
�5 wA�s boLr> .
I certify that I have authorized (agent) rA to act oa my
behalf, for the purpose of applying for and obtaining all CANNA Permits necessary to
install or construct (activity) l ► h UDC4,
at (location)�� r'
This certification, is valid thru (date)
Signature ZZ
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX; 252-247-33301 Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Fmpioyer — 50%, Recycled h S 0% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHO USE)
I hereby certify that I own property adjacent to Z4� F7 's
property located at
(Name of Property Owner)
5)(- 31w h
(Street Address, Lot, Block, Road, etc.)
on 6J 6.1 X(f 0!, in (fa , N.C.
(Waterbody) (Town and/or County)
He/she has described to me, as shown below, the development he/she is proposing at that
location and I have no objections to this proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (I T) from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(initials
I do agree to waive the 15' setback requirement.
(initials)
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
22
z a"-t -
Signature
Print or Type Name
Telephone Number
Pate: _ — `0 q --

.1 0-1 1-] © S

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ( / G A4 6n2a-'s
(Name of Property Owner)
property located at
(Street Address, Lot, Block, Road, etc.)
on Z,/ �%�/� , n (�1 ��1� , N.C.
(Waterbody) (Town and/or County)
He/she has described to me, as shown below, the development he/she is proposing at that
location and I have no objections to this proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(initia
I do agree to waive the 15' setback requirement.
(initials)
--------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
_________.-_------------------------------ ----------------------------- -- ------------------------
igtiature
Print or 'type Name
Telephone Number
Date:

5
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WILMA W. PFAFF
543 Riverside Drive 336-798-1791
Lexington, NC 27292
Pay to the �p
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Date BRANCH 0056566
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