59706_STATE OF NC_20120109

❑ CAMA / ❑ DREDGE & FILL
GENERAL 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 I SA NCAC
F-1 Rules attached.
Applicant Name
r
�?�;-§p C
Address �'
(n I i '!�3G1 j 0-JVA
dd
Ci10
State 1\) ( ZIP 7-%570
Phone # (`)
Fax #
Authorized Agent
r
er.c 6v A�j
Affected ❑ CW
❑ EW O PTA ff] ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
CityZIP
Phone # O River Basin
Adj. Wtr. Body (7 (nat /man /unkn)
Closest Maj. Wtr. Body
'Vol -
MEN
■■■
i
0
■�■
■■■■■P ■i■■■■
■■■■■■■
'■■■■■f1Ir1■li■■�rZ■"�6uQ11�11!t�i�7!!■ill: ■Rl r.!!07JR1111■_,.
- mom i w�■�■ii�i�■�■■i�of�iiiaiii
■Y■■■ t WN&AFRENWOMIRW iM■■CITIMIX""Im
MEMMUMENIME
-■�■■■■®I�■■l�■Ail■■■■V!■w■1�■lG�l�Nl1\11■I�■■
■■■■■■■i�iii■Yi'ail■ii%i�GiiL�i� ■i�ii�i ■■■boom
. MENC :C :: :::WIN.' �:��:C� E
.■■■■■■►L;I11�•`�r�■■G1■t�JlTTi7YGl.I■■■■■�sZ�7l�■�i�ylt►,�.'A.
.. - �■■��■il■■■■■■■■■■■■■■■■!��■AEI■■■■■
■■� MOMMEMEMMOME
MOOMMEN
N■■EMEN■r■■,■EI-11■1111■
• • . _ EMMMEN mom■�■■■■■■■■■■■■■■■■■■■■■
' •• • •■ ■■�EMMEE■■■■MEM .OMME ■
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
�f -
Application Fee(s) Check #
Permit Officer's,5ignature
) WIZ. I I
IssuiAg ate Expiration Date
Local Planning Jurisdiction Rover File Name
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
�f -
Application Fee(s) Check #
Permit Officer's,5ignature
) WIZ. I I
IssuiAg ate 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:
❑ 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.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

7RN-09-2012 09:02 From:NCDOT 2522232105 To:92473330 P.2/2
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Saves Perdue, Governor James H. Gregson, Olrector Doe Freeman, Secretary
Date �ZbzZ`
Applicant Nan1e
Mailing Address
T-ATC m-� N t 12r H CA M o I i N
r certify that Y have authorized (agent) CA aTe l.lT1to act on my
behalf, for the purpose of applying for and obtaining all CAjMA Perujits necessary to
install or construct (activity) ! l~S i C -
at (location)6A Pk 0& 1-A#JD CA 1)'$15W!
This certifica
Signatur'9�
ali i�fu (date,) "` 6+ u
400 Commerce Avenue, Morehead City, Wh Carolina 28557
Phone, 262-808-28081 PAX; 252-247.33301 Internet; wwnecoestalmanagement,net
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Pmp©r