57952_PEDERSEN, LYNNE_20110601

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❑ (' 4Mz1 / ❑DREDGE &FILL �
C NERAL 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 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
Phone # ()_
Authorized Agent _
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # O .
DEW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Nam
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit ** Issuing Date
Application Fee(s)
Check #
Local Planning Jurisdiction
� r
Expiration Date
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/ 1-888ARCOAST
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

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Lynne Pederson
Date: June 1, 2011
General Permit #: 57952C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
LM
Dredge ❑ Fill ❑ Both ❑ Other ®
48
48
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
384
384
HG
Dredge ❑ Fill ❑ Both ❑ Other ®
60
60
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 ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised:02/03/10

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1092-11-5
1092-11-d
92-11-3
-11-6
1092-1 4-8
1092-14-11
I092-14-12
1092-1 4-10
1092-14-9
;�3•ti Mnlsn �/"'"�
S�.N•' t7r �fei ZL.
1092-14-6 GOW
1092-14-13
1092-14-14
1092-8-A
Pamlico County, NC Parcel Number:
1092-14-7
y NC PIN:
6487600308
Owner Name:
PEDERSEN LYNNE B
ry'o PROPERTY MAP owner Names:
e*`tf
Owner Address:
7017 FAIRWINDS DRIVE
Owner City:
ORIENTAL
<` -4 D1soe1mef Owner State:
The data provided on this map are prepared for the Inventory of reel property found within
Pamlico County, NC from dead., Owner Zip:
NC
28571
and are compiled recorded plats, and other public records
-jq '-" anddata. This data is for Informational only and should not be substituted Situs
purposes Address:
�/)I CAINN ``� for a true title search, property appraisal, survey, or for zoning veri9cation. Legal Desc:
LOT 7 FAIRWINDS SUB
2.09A
oft)- gq-
I092-17 �oy9
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Iw
Fti�cttc��llc� Nt.
zB 31d1,
NNE B
! 13.%
1092-8-B
1092-10
1092-8-C
AV
Deed Book:
407
Deed Page:
38
Plat:
N/S SR 1308
Deed Acres:
Land Value:
0
15625
Building Value:
0
N
Value:
15625
Sale Date:
[unsupported data type]
Sale Price:
0 One Inch = 100 Feet

OAVA
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NCDENF
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 S p, I I
Applicant Name L Y VIII C 1' It� f f S If h
Mailing Address
F••:,r\,I,A�5 0�-
0'r t\A'-\ NL, �'q5 11
I certify that I have authorized (agent) I �3x M "mr, --\ z to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) �� P,'Cr
at (location) 7ti i 7 P,0r, C) r, e-hArn\
This certification is valid thru (date)
Signature Y\ 1, ,
1 y(-1-- )aokG-
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit: Lyhhe 7c�e%r5 v\
Address of Property: 7o
P
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
10 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the
(Applicant Information)
PO dux 1 \0
Mailing Address
Ur -.-CAA , 4 C- )�85'11
City/State2ip
'� 5),- 3
Telephone Number
5/1),/11
1 `Date `
�1ehSL �z\�'Sh `t0 , 0`^ �'\x kv
15' setback requirement.
(Riparian P�pp0,gyj0wner Information)
Signature
Print or Type Name
x ,o--4Y4-y00,
Telephone Number
Date
';�5A.— �'4ec1— AW),A . `i�n•th1C Yo'J.

MAY-24-2011 10:22 IL GAMING BD DES PLAINES 847 294 4890 P.002
CERTIF�A IL - REQUESTED
DIVOM OF COASTAL MII►h1ACEM ENT
ADJACENT R1PA FAN PROPERTY OWNER NOTWCAUMMAlVER FORM
Name of lmftidual applying for Permit: Lghhe �t dev S�vti
Address of Property: 707 F•:r tih�S
NC. ;,6571
(tow beettt Sheet or road. C* s Court/)
I hereby cWW that 1 own properly adjeoe t to the above r+efe m;ed property_ The mchvAMI
applying forvft permit has da=&W b rae as ahmn on the :Hart P drawing the devolo nm t
OW are proposing. A dorsilrlion or drawing, wilh drrrensions~ should be provided with Il is letter.
_ 1 have no abj--bons_io Vft.prOpOs& _
ff you have o&gJecboas to what is.beft proposed, pk�& n.tdr Me arvlWOP of 0085011
ARanagerna�rr;Ie0pQaarQrerosAw Max Cft,/MC,2WWoroslt(2SV-8 2M )
f0daysofrooefptofhVsnot&NomWorswiseorUWffadllrs=rrearsno-04%C GO13+Tyou
he" been noted by Carped MidL
7cio WAIVER SECT10�1
f
i understand that a pier. dodo, n1cwi9 pirg4 h sid Malec, boof wtme� bodW orgarxibap
must be set bade a mQwnum deal I ' ' I of 15 *0m,my area of riparian secaos unlabs walred i7)I
ma. (1f y m wish b0 wsl4 the eelbad� you must ir�al the �propriale blank below )
1 do wish 1Dvalve the 15 seftKxk requtrerne*
I do rwt wish ID waim the 15 sea uck neclLftmerrt
(Applleark hdoemallon)
AoISA g Ad"M
^. J T
;elephorre Number
51u0i I
,Dadc
ko
(UPwaftn P.opert7/ Owner kdwnn dJon)
Prk*orType Name
X S'317 h 30 s��a
Tskp'xm Nmdw
TOTAL P.002

1196
IBX
531
PO BOX 190 , C ' 6630/472
ORIENTAL, NC 28571 0 4�
n Date
Pay to the NCDE $ ..0'zoo• oo
Order of
ll � Dollars
First Citizens ® ��- Bank
firstcitizens.com c1 �G2�5C
For �e Nn� G
.053 1003001:0047 120 21 25411■ 0 L L96
..x

SUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the -Tar-Pamlico &
Meuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259.
The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of
Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies
with the aforementioned regulations, and made a "no practical alternatives" determination per those
regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer
Authorization as long as the project is constructed in a manner that continues to meet all of the conditions
listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party
(contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per
violation.
1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.
The alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of
pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules
to the maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way.
This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the conditio
verify that all information provided is complete and accurate. ,--) ,
(Age or App ' ant Printed I4a4ie
X/
Agent or Applicant Signature
CAMA GENERAL PERMIT #: l /
Washington Office
943 Washington Square Mall
Washington, NC 27889
Phone[phone]
Morehead City Office
400 Commerce Avenue
Morehead City, NC 28557
Phone [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
Version 5, 09/2009