55333_SAIN, CHARLES_20100415

❑CAMA / ❑ DREDGE & FILL
GEsNERAL PERMIT
❑Jew ❑Modification ❑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_
"//(o -/O /
Previous permit #
Date previous permit issued
Rules attached.
Applicant Name
Project Location: County
Address'
,t
i nt-
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Street Address/ State Road/ Lot #(s) r1
rf
City ` f' 1`_X
State OC
ZIP -� -7r0 ",
Phone # f ' t'
Fax
#
Subdivision
Authorized Agent
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Ci ;" . ZIP
ty
ElCW
Affected
ElEW
[I PTA
'EIES
ElPTS
Phone # ( - River Basin
❑ OEA
7 HHF
❑ IH
❑ UBA
❑ N/A
� r .-
AEC(s): El PWS: ❑FC: Adj. vvtr. Body \! •f k t gnat /man /unkn)
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
r
Type of Project/ Activity
^� (Scale: / 5 )
Pier (dock) length
Platform(s) I
Finger pier(s) l
Groin length
number
Bulkhead/
avg dRlength tancere -
max distance offshore I
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing -- I I
Other
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-
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Shoreline Length
SAV: not sure yes -60
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 1- - -
j
-
River
E # f ..
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�/
❑ See note
• U,p�,i
on back regarding
;
Basin
rules.
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Agent or Applicant Printed Name
)fficers ignature
A
Signature Please read compliance statement on back of permit I', ling Dated i xpira7(( ate
ApplicationFee(s) Check# Local PlanningJurisdiction Rover File Name

1
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
Iandowner(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/ I-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

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
Date f %
Applicant Name i S
Mailing Address 6 G� co �—G d ' SIT —
I certify that I have authorized (agent) l,t) f I 1 i 0jq�? I wi y�; to act on my
S�C(r
behalf, for the purpose of applying for and obtaininCJ�73 %g a� CAMA Permits necessary to
install or construct (activity)
at (location) / 0 :SI/I
This certifi
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.n=astalmanagement.net
An Equal opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to C � ZaA )/:-
(Name of Property Owner)
property located at 160 J 44,
(Lot,
etc.)
on 4/ in 13a c , N.C.
(Water ody) (Town and/or ounty)
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 developnw i �©S
t�
ztwill i
Signature
Print ol Type Name
S� to `�� 17 �
Telephone Number
Date: �I //0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBBOA/TLIFTBOATHOUSE)
I hereby certify that I own property adjacent to A , �.�i 's
(Name of Property Owner)
property located at
16
(Lot,
Road, etc.)
on �i� P �� P in &c A ✓ , N.C.
(Waterbody) (Town and/or unty)
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)
I
V
Signature
Print or Type Name
Telephone Number
Date: / Lo

NC Division of Coastal Mgt. Habitat Impact Computer She
Applicant: Charles Sain
Date: April 15, 2010
General Permit #: 55333C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
HG
Dredge ❑ Fill O Both ❑ Other ❑
2,000
2,000
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
-803- B -: 1« T t.ngt revised: iO3i1a

BARBARA ANNE SAIN 5698
901 COURTLAND ST 66-112/531
GREENSBORO, NC 27401-1711
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BRANCH BANKING AND TRUST COMPANY
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