60128_SHEETS, RANDY_20120420

LAMA / 7—DREDGE & FILL
r-J O o. 60128
GENERAL PERMIT
Previous permit#
[-]New h,Modification .-]Complete Reissue
'iPartial 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 a CW _ EW 71 PTA ES J PTS
Phone # (_ ) River Basin
s ❑ OEA ❑ HHF _i IH ❑ UBA ] N/A
AEC:
Ad'. Wtr. Body i y (nat /man /unkn)
I-: PWS: FC:
ORW: yes / no PNA yes / no Crit.Hab.
Closest Maj. Wtr. Body
yes / no
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
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
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A building permit may be required by:
Notes/ Special Conditions
See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s)
Issuing Date
Check# Local PlanningJurisdiction
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)

■ Complete items 1, 2, and 3. Also complete
j item 4 if Restricted Delivery Is desired,
+ ■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
10�� `nC ar7330
A. SI nature
X a�' icL4 � t✓U z� 0 Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
GcO(t,,; ,i'L-� Vrz
D. Is delivery address different from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type h
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise i
❑ Insured Mail ❑ C.O.D. �
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. (Transfer
nsferle urom 7004 1,350 0001, 6538 4957
(transfer from service labs
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
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T12-91NAGE CONSTRUCTIMi & TRUCKING, INC.
2373 NC HWY 304
BAYBORO, NC 28515
[phone]
pp(
DATE TO TEIE ORDER OF
Wells Fargo Bank, N.A.
DATE f" 1/0 Cc.,,Ij' NIT
u I V) A cd 2 U:J I U UU t A"I 0. L 0 0 7,5 2 LIU J C3U 5 gilm
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CHECK
Aj'vi&JNr
[DOLLARS
:HECK NO.
ef
7,95;2, s Fz o I

N.C. DIVISION OF CCIASTAL MANAGEMENT
AGENT AUTHCIRIZATION FORM
Date , oZa—
Name of Property Owner Applying for Pern it:
Mailing Address:
OQ �T;�, L
l certify that Y have authorized (ugent)1
behalf, for the purpose of applying for and
install or construct (activity)
at (my property located at) /7,j 64''
This certification is valid thru (date)
Property Ownc+ Signature
ining all CAMA Permits
to act on my
to
ZLfs 1-7/
t„2:a6ed Ob2SSb2 6:01 AiDGHW WOQ:WOJd 2-2:2Z 2T02-02-adW

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to AD it Dff�'�r AP 5�kr!�-E5- 's
(Name of Property Owner)
property located at C o 7' 1 , P i-u FF 14A
(Lot, Block, Road, etc.)
on `T�o�l%CA) �r �� , in �16 , N.C.
(Waterbody) (Town and/ r County)
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 by individual proposing development)
Signature
y
Print or Type Name
Telephone Number

March 26. 2012
Phvilis.
Ne are eoing to replace our dock. as it was destroyed during the storm. CAMA said we need to send
you an Adjacent Riparian Property Owner Notification /Waiver Form. So here it is, if you have any
objections, you need to write or call them. If you do not, then you don't have to do anything. They said
to send it certified mail, so I am following their instructions.
?h s.
Randy