54662_SHALLCROSS, JAMES_20091102

CAMA / DREDGE & FILL
GENET_ PERMIT
❑New ❑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
Applicant Name
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Address
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City
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ZIP }'
Phone # Fax #
Authorized Agent
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Affected
❑ EW ❑ PTA El ES ElPTS
AEC(s): ElOEA
❑ HHF ❑ IH ElUBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no
PNA yes / no
Crit.Hab. yes / no
46F3
Previous permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
❑Rules attached
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Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or,Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer's Signature j ,+
Issuing bate Expirat on Date
Local Planning)urisdiction Rover File Name

.03
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)
Revised 08/09/06 j

t iY y� NCDENR
Nq�{h Carolina Department of Environment and Natural Resources
OCT 2 6 ZU Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date
Name of Property Owner Applying for Permit:
Mailing Address:
1 2 0 )41ZLM" Or tl Lc
I certify that I have authorized (agent) (.� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) 0�A� L
This certification is valid thru (date)
©7//RM,ISV7//%M
Owner Signicture Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post consumer Paper

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent toX N1 {LL Cj�9s
( ame of Property Owner)
property located at x
(Lot, Block,
etc.)
S
on BOGOP,C5 QUS(T) /1 in T 1 s , N.C.
(Waterbody) (Town and/or County) �\
Applicant's phone #:X2Z2-g243S-6Mailing Address: K / 9-� Df��� � (fig,
C zgtZ) 2--
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 property owner proposing development)
Ir4<.L1� wrscL
-------------------------------------------
(Information for Property Owner Applying
for Permit)
f 1�z 0,4Kt.e-ge DP.
Mailing Address
Z-
City/State Zip
2s2 - 2-V 7 3s,6
lephone Number
ignature a e
z
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(Riparian Property Owner Information) ~�
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Signature
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Print or Type Name
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Telephone Number
Date

-�� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
OCT 2 L
a _ I hereby certify that I own property adjacent to !�V�'j ��LL CjSs
(Name of Property Owner)
property located at
(Lot, Block,
etc.)
onBoG u in N.C.
(Waterbody) (Town and/or County) l
Applicant's phone #: x25"�2-Y24 3-5 -G Mailing Address: K
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 property owner proposing development)
t ,'P �\
(Information for Property Owner Applying
for Permit)
Mailing Address
.S M.�l
City/State Zip
Z-2--V7-63�,6
lephone Num�er
YY (-
ignature `Date j
IoofyS'y 3/
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------------ h--�---------------------- ----- (Riparian Property Property Owner Information)
Sigriature
Print or Type Name
Telephone Number
Date

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