56357_SMITH, CARL_20100908

CAMA / ❑ DREDGE & FILL 3
GENERAL PERMIT Previous permit #
1New ElModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As a6thorized 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
ERRules attached.
Applicant Name_ E ' Project Location: County
Address_
City
Phone # ()_
Authorized Agent,
Affected ❑ CW
AEC(s): OEA
❑ PWS:
ORW: yes / no
_ State
Fax # ( )
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
ti
ZIP
ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (`) River Basin
Adj. Wtr. Body (-nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signatures Please read 5?myliance statement on back of permit
10
Application Fee(s) Check #
PermitOfficer'sSignature---
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Issuing Date Expiration bate
\ 076)
Local Planning jurisdiction Rover Fil Nam

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 complywith 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

Applicant: ���/�✓ � � �/ V
Cate:.1
I�
! S/ (0
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measu Ment
I
ound in your Habitat code sheet.
Habitat Name
DISTURB TYPE
DISTURB
One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tem im acts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
U✓ `
redge ❑ 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 ❑
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 ❑
., Jam ^.::.» a _; •: , ;.+ . - 1 i i �'t

i
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date �—� —/ v
Name of Property Owner Applying for Permit:
Mailing Address:
'e i�i- /a 5
r; o h-, r—c T I /✓C— 2 5�'fi 2
I certify that I have authorized (agent) -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) J 0 T k c) Pal \ Vie- �- t) (�-- b r 10
This certification is valid thru (date)
O
"q _.. Q
Property Owner Signature
Date
�D
c_
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to [' /4--# C, Z164 / 7—% 's
(Name of ProperIX Owner)
property located at /0 /2,4 L-#1 r t'r0 f i
(Lot, Block, Road, etc.)
on O f�-k in L',6ic i9 O ;., ' ,4 rG L , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q ofO 5E:q� 7 Mailing Address: 62 1-404
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 eC', �0 �
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
G 6.s�t re R I f Iv,,a, Z'9 -5-22
City/State/Zip
ql,a - y 7 Z
Telephone Number
Signature
Date
� O q iS sty -J1
Print or Type Name
9 62 -3s
Telephone Number
-27 -iv
Date

i
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUS'E")
I hereby certify that I own property adjacent to � � S .!� 's
(Name of Property Owner)
property located at 1 a tf� �- r✓! �ro L2 ,
(Lot, Block, Road, etc.)
d�` U
on TrCC4 J� i �/!= (� in �� rl T-C5-r , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:1l0.3,Y ?-47 4 Mailing Address: P 0 ,6 x / `E 5
/) _�, r- A7N 7-/ /n C_- 2&5 Z z
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)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
0 --�? B' q-- 96 ~7 41-
Telleephone Number
Signature
Date
RECEIVED
SEP 7 NO
Morehead City DCM
(Riparian Property Owner Information)
fybrfi e 06 chf-cv�J Signature
Print or Type Name
70 7d-,2 J r 70Y, d'i , 9y7a
Telephone Number
Date

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PUR HASER, SIGNER FOR DRAWER Y COMPRADOR, FIRMA DEL LIBRADOR
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PURLHASER, SIGNER FOR DRAWER / COMPRADOR, FIRMA DEL LIBRADOR
PURCHASER, BY SIGNING YOU AGREE TO THE SERVICE CHARGE AND OTHER TERMS ON THE REVERSE SIDE
ADDRESS:/
DIRECCION:
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Payable Through ISSUER/DRA ER:
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