60108_SANDERS, JIM_20120508

CAMA / DREDGE & FILL rL NO. 60108
GENERAL PERMIT Previous permit#
[]New ❑Modification ClComplete 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 _ State ZIP
Phone # () Fax # (-__-_) Subdivision
Authorized Agent City ZIP -
Affected ❑ CW ❑ EW PTA - ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA I HHF ❑ IH UBA ❑ N/A Adj. Wtr. Body gnat /man /unkn)
[IPWS FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/Boatlift x!�
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale:
4 .
See note on back regarding River Basin rules.
Permit Officer's Signature
)I
7
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Issuing Date
Check # Local Planningf urisdiction
Expiration Date
Rover File Name

r
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, certifythat 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/ 1-888-4RCOAST
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)

ROBERT D. BASKERVILL, JR.
NCDL # 2993158 PH# [phone]
384 BEARD'S CREEK DRIVE
ARAPAHOE, NC 28510
Pay to the
Order of _
5024
66-30/531
Y 472
Date
$a�oo
Dollars
®First Citizens
Bank
�-
For
11:0 6 31003001:00471750471111' 05024

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date --�/ / / / 2--
Name of Property Owner Applying for Permit:
1
Mailing Address:
rol
I certify that I have authorized (agent) bd�5��� I to act on my
behalf, for the purpose of applying for and obtaining all CAM jA Permits necessary to
install or construct (activity) ? o"'i ! 17' ( ¢ ��f� t Lc,1y i l �ec'll-)
at (my property located at) �3��s'12
This certification is valid thru (date) f
Owner Signature
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
hereby certify that I own property adjacent to Tlmr �R va(P� _'s
(Name of Property Owner)
property located at 33
(Address, Lot, Block, Road, etc.)
onin > N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #:��� S15 �l I/%' I Mailing Address:��-
Agent's phone #: � � G; L ' / V 5fO /1-ft� � 161 C . FSI 0
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
r
C ee
3
1
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o�
§ AA el--6 p to p
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.nccoastalmangement.nebcontact 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.
(Property Owner Infp.Cmation)
jg-naatture
\)nh �A/ggVIs
Print or Type Name
-33 % R?4ftJ,51 64ew- �,
Mailing Address
City/Sta e2ip
Telephone Number
Date
(Riparian Property Own In or aat�ijo�n)
Signature
LL
Print or Type Name
3 �5-
.C-,Pud bn
Mailing Address
Az A Y) "� 4a-e-
�, c . ;g--,--w
City/Stat Zip
ag
- I 3
Telephone Number
l/
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
hereby certify that I own property adjacent to /.?ln J.- s
(Name of Property Owner)
property located at 33
(Address, Lot, Block, Road, etc.)
on e cis C � �� /L , in /%A c? � N'r C =� , N.C.
(Waterbody) (CitylTown and/or County)
Agent's Name #: & .i &1 S Yrl i// Mailing Address:
Agent's phone #:I
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
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.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Cerdfigd Mail.
roperty Owner InforrAation)
Sir nature /
Print or Type Name
Mailing Address
41000,1),V-f,-�
Cityty/�e/Zip
Telephone Number
5-Al
(Riparian Pro
Signature
Print or Type Name
Mailing Address
n%vJ BtpAl-
City/StatelZip
- ) 637- �CRd
lephone Number /
Date