58881_PADGETT, THOMAS_20110930

' ❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
IlNew ❑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 ` a
Address U �
City_ grkk-, State /JC ZIP Z�s433
Phone # (.__) Fax # (�)
Authorized Agent h p w• C .1 L r; WV' if ^ r �
Affected CW ❑ EW ❑ PTA Z ES O PTS
A
Affecte El OEA ElHHF [IIH ElUBA ❑ 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)
p �
Subdivision : (rc r +� c
City Jt ewe 1 zip
Phone # River Basin � , "I, �c
Adj. Wtr. Body ;f\, f r _ (nat /man /unkn)
Closest Maj. Wtr. Body
LINES
1111111111111110
ME
1111111111011019
E
MIN
MINE
distance offshore
M
.
MEIN
No
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"AIP
notsure yes 0 0
•.bags:
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Bulldozing
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing ate (� Expiration Date
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 [)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 howto 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 Cif Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
66Z, cu 10160 k-L Jak1 yI s
JV O 224 -33
I certify that I have authorized (agent) —r4 0 tl%t S L LAIl( Oct,, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
I /
install or construct (activity) cR 1 yt 3 a K �' t,�� StGI.✓Gi' �! ,
at (my property located at) —7Y Q cu
This certification is valid thru (date)
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent t�(Nalmoe
�prty u---- s
��O#
property located at �0a - �} 7'�' BCI!l s9 IAC SYI-&Aj
(Lot, Block, Road, etc.)
Oil in �2 J N.C.
(Water ody) (Town and/or County)
Applicant's phone #: boa �� 4�ds Mailing Address: W, f Ili^.
W k-6ti , A , Z�4 33
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 be filled in byLproper(y owner proposing development) Q l
}Ylltr Gc'i �a� i I�Q' S+�H tr7aY S2G�1/°�i it
-6 pCt�V�S /1 /�
s4LW)-,;- 44- 0.t �tck O �yJijiVl
(Information for Property Owner Applying
for Permit)
adz ROL141�-
Mailing Address
City/State/Zip
4T-qone Number
a
Signature Lale
� Ad
(Riparian Property Owner Information)
ignature
Print or Type Name
3--�
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to - a Jad/ t• 's
(Name of F4oper6 Owner)
property located at
(Lot, I#lock, Road, etc.)
on �/,CAoin 5f-I- Lvi N.C.
(Wate ody) (Town and/or County)
6,q Z (Z�aldflraKik,>�S ,�
Applicant's phone Ala��� if Mailing Address:
�Bu�t��a,Nc- 33
lie 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 be filled in by property owner proposing development)
�C 4-o CoAs4;,►c,4- A -74 -Cao4- (o`e".) 511 4�Ac. •--PaAk1 SCkWdtl
Gt �ok tom' SA,-11A 4 5 �� 111�-C �itltiit�� 7c� K✓�S1cl� �fi►�
C IA,(VJ(CA �� J
41. u-7-7
---------------------------------------------------------- - - ---------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
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Mailing Address ' Signature
,EJEL 1-�) J oA
l�lp ✓�� 1 �� ��3 � �Co is � �L.So�
City/State/Zipl Print or Type Name
Tejrphone Number
91�� M � 9 /7 JW
Signature Date
9-iZ-/)
Telephone Number
Date