59697_PEELE, RICK_20111213

1-1 LAMA / --1 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 15A NCAC
Applicant Name
c_ 't jC
Address
State (- zip -)SYS
Phone # (— _)
-------- Fax# ( )
Authorized Agent
A-1 4*4 &OdI T
Affected ❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
(Y
Previous permit #
Date previous permit issued
El Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
y5 `1 ►i. -v� , � �..��.
Subdivision
City zip
Phone # `)11(�-3�!� River Basin \4 !�'ff Ot
Adj. Wtr. Body ; -,J Q (, nat man unkn
Closest Maj. Wtr. Body Gru —3n, — " — —
3
Agent or Applicant Printed Name Permit Officer's Signature
i
Signature * Please read compliance statement on back of permit Issuing Date Expiration Date
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 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.
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

PAY
TO THE
ORDER OF
SHORELINE PIERS & BOAT LIFTS, INC.
DBA SHORELINE MARINE CONSTRUCTION
580 PEARSON CIR 252-393-7934
NEWPORT, NC 28570
G,U�
1368
DATE O' -� ✓ J 66.30/341
341
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® First Citizens
pFOR 7Z, 6-/ P -- -- -- -- "r
11100 L368u' i:053 L003001:0034 L 23 890 2

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: (mil Gy r I-c
Address of Property: ✓ 41 � L l:;tA e-
(Lot or Street #, Street or Road, City & County)
Applicant phone#: qi "! - q l I " 0 1 Mailing Address: 0�2 I 70/-r'e p -S Driv'_
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, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact-dcm.htm or by calling 1-888-4RCOAST. 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, or lift 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
rty Owner Infofrrnao6n)
narure
Print or Type Name
Aa/ Or ;�tieS
�M ' ng Address
�
City/Stat /Zip
�11q_ �/� (?-- (37f�7
Telephone Number
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Dale
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DEC 12 2011
IT
(Riparian rty forma' rn)DC
rrY
Signe ur
;_.PA� CO fzr- YJ
Print or Type Name
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Mailing Address
City/State/Zip
cII Iq-U14 AI 8�
Telephone Number
Dare
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PEE I-E DO CK
941 L40a
F

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date I ( I — I
Name of jProperty Owner Applying for Permit:
Mailing Address: R&CEI'JED
A,,S t -1v DEC 12 2011
C iI' c- ;2 DCM-MHDCITY
I certify that I have authorized (agent) �'����%� to act on my
behalf, for the purpose of applying for and obtaining all
CAMA Permits necessary to
install or construct (activity) p� �,, d 66-d �
at (my property located at) 4— G CYn e- -4 1F-r- tj C--
This certification is valid thru (date)
/\, 4�v
Property Owner Signature
3®31-1-.1-
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY pOWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: elGL f� i
Address of Property: 5,111 1 le ,4451e+ L CiA C-
(Lot or Street #, Street or Road, City & County)
Applicant phone #: -! i -! q l I " j q t Mailing Address: ,�2 1 7-o'n-f4 h":' Dr-ry <—
cv, -�� /J C- A -75'13
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, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. 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, or lift 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.)
RECEIVED
I do wish to waive the 15' setback requirement.
xI do not wish to waive the 15' setback requirement.
DEC 12 2011
CITY
(Pro erty Owner Infor i )
Si nature � j
Print or Type Name
,P-( err AJ6 r�
Mailing Address
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City/State ip
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Telephone Number
(Ri
Information)
Print or Type ame
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Mailing Address
City/State2ip _ 5�qI
Telephone Nu7/;
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Dale Bale.

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