61037_RAMSEY, BEN_20120814

L-'CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New ❑ Modiification ❑ 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
P- 'Po No. 61037
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name s N� Project Location: County
Address ` ! Street Address/ State Road/ Lot #(s)
City
-State ZIP
Phone # ()
Fax #
Authorized Agent
Affected ❑ CW
D EW ❑ PTA L] ES F PTS
AEC(s): J OEA
El HHF ❑ IH 71 UBA —1 N/A
L_1 PWS:
^FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshoi
max distance offshc
Basin. channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure
Sandbags: not sure
Moratorium: n/a
Photos:
Waiver Attached: yes 'no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Subdivision
City �,a t 'i.0 J ZIP
Phone # ( __)� _ +�' River Basin
Adj. Wtr. Body Mf",,,I1 rL, - Q t i ' (nay /maan /unkn)
Closest Maj. Wtr. Body
(Scale: //� ) 4 )
See note on back regarding River Basin rules.
Permit Officer's Signature J
Issuing Date 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 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:
F ; Tar - Pamlico River Basin Buffer Rules ❑ Other:
E] 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/ 1-888-4RCOAST
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)

NCDENR
r North Carolina Depaftment of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date _ • `
n /
Applicant Name _ P e-,VL � / & hA-
Mailing Address _ 0;,2 f tf-�a/d�� It k�tk- t
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) ,
at (Iocation) y %vy /Z"j , ruui /U..L
This certification is valid thru (date)
Signature. �`--
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaim'anagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 13Cv" 14. k'a'm'- .y 's
(Name f Prope wner)
property located at O lsflw LW � / 3 ';I
Address, Lo dock, Road, etc.)
on Gor-t Sew , in
N.C.
(Waterbody) City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iota ion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.)
fCS I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Cit State/Zip -
336- Sr-r300
Telephone Number
Date
(Adjacent Property Owner Information)
Si nature
-�nt or T 5 G p!
Mai ng Address ,
Cit /state/zip
5-2 -23
Thone Number
T / f -,z c� / 2_
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 13C'm 14. Zq mt5ay 's
(Name Propertywner)
property located at 0 'S f" Lv � N C _ R P _ / 3 '7j
on Gor-!. Cjcw'J Address, Lo plock, Road, etc.)
, in , N.C.
(Waterbody) City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca ion.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
.S 1
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.)
A6-5 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
-i � c-►+- nF'4
-
Print or Type Name
4.21 At"Ic-
Ma'rng Addo�res
S h.cb•60 _A) Z2ZDT
Crty/State/Zip ,
316- SS"3-S3oy
Telephone Number
'6"- // - .2,012
Date
(Adjacent Property Owner Information)
Si nature
P 'nt or Type/ N� me
-� 3"S D P `�i'- / b /
M�"aiiy ng Ad ress
�Yr4L Z v C, A-Z
Cit /State/Zip
s 2 - lea
Tehone Number
7-//—':26)/2�
Date
(Revised 6/18/2012)