53687_ROUSE, DWIGHT_20090526

;LAMA / D DREDGE & FILL
GENERAL PERMIT 1 revious 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 f and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC t 'l
mules attached.
Applicant Name
_
Address'
^
`'
City'!) d
\ State ` ZIP ..
Phone # (�
7�ax # ()
Authorized Agent
f
ElCW
i�tW/ [-PTA ❑ ES ❑ PTS
Affected
AEC(s): ElOEA
ElHHF ❑ IH ElUBA ElN/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County_
Street Address/ State Road/ Lot #(s)
Subdivision
�- L, ZIP
City" - t
Phone # ( ) River Basin (.j Q/i i fir cc t
Ad Wtr. Bodv( l ' 't �_ �_ k/ ) (nat /man /unkn)
Closest Maj. Wtr. Body—�_
Type of Project/ Activity
(Scale: ✓�, )
Pier (dock) length
Platform(s) - �-_�_---- '--- __ ..-:-t---- -- -__- --
Ll
Finger pier(s)-_ - - -1
Groin length
number
Bulkhead/ Riprap length
-
-
I
I
--
-
-
avg distance offshore
max distance offshore
Basin, channel `
-
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other—
Shoreline-�
h
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
I
-
=-
�-
River Basin rules.
_
I�
I�
I
-
f
-
--I
i
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_
i
- -
-,- - -
--
-
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-
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-
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on back regarding
❑ See note
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit icer's Signature
Issuing ate ) Exp'iration'Date
1 r _�% f
Local Plan ning)uri`sdiction 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 I) 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 consistentwith 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/ 1-888ARCOAST
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

A
1
A
NCDENR
North Carolina Department of Environment and Natural Resources i1�y
Division of Coastal Management ri
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date 4, 2 2 ' 094
Name of Property Owner Applying for Permit:
Ji,-:(G&,i' R®uS t
Mailing Address:
/<, iu S r o iU/ ALL D 3
I certify that I have authorized (agent) % v 4 - � v cK n} to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) d e �o(� '4 7 -�L- ► %J
at (my property located at) -1- S N ¢ — 6 r
This certification is valid thru (date)
Property Owner Signature Date
ell
•Y�
400 Cotrierce Avenue, Morehead ±City, North Carolina 28557
Phone: [phone] FAX;_ 252 247-33301 Internet: wwwticcoastalmanagement.net
An Equal Opportunity,Vffirmative Action Employer —50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adja�ce(nt to
JA s
(Name f Property Owner) , -
:�,.
property located at/ 2 2
(Lot, Block, Road, etc.)%
one---y , in
(Waterbody) (Town and/or County)
Applicant's phone #: 2S Z Mailing Address: D 3a�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual p-oposing development)
S� L
L r I L.--k I s+ l hl' ) ID 0 c-1
4% a
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
P. -0 f3 0,-(- ) -
Mailing Address Signature
V i N -Q, 2,�?<)o3
ity�/Zip-
2 S 2 —J
Telephone Number
Print or Type Name
"7 !,z 3- 7 q(' 17
Telephone Number
Z-2 6 5"
Signature Date Date
Q � ► .'3,�o
42 r `- I-)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to �w ; � 10 Iy.�, 6 s
(Name of Property Owner)
property located at 2 2 ' j u v rL ►'� ��" l v L�
(Lot, Block, Road, etc.)
on C ►^• ►3 C , in A- L, q r,4 t c' B I✓ ►9 L , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 2S2 34) 91.n Mailing Address: -P' ° 1'5 S--j
N -c. 21` S-o
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
`S f _
"C
EE ) -�, 4 , '.5 -D -)C- �--- :;-6 � I z y- I lo -,-3
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
P C) gC)x )S's 1
Mailing Address
KINS'LIN N L03
City/State/Zip
252
Telephone Number
C
Signature Date
C �
Signature
Print or Type Name
—726 -Z4s6S
) 0 - Z n -
Telephone Number
Date

MUD BUCKET DREDGING, INC.
PH.252-241-1504
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557
PAY
TO THE
ORDER OF (/
3762
66-112/531
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