54126_SMITH, C.W_20090601

G-IZ-<)C,' C.56
❑CAMA / ❑ DREDGE & FILL,.! 06C
GENERAL PERMIT Previous per�it #
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
i
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
F7 Rules attached. a
Applicant Name
Address
City uc,t 'c" State �� ZIP
Phone # ()
Fax #AA
Authorized Agent
,�()
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Affected ❑ CW
❑ EW ❑ PTA ❑ 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)
is
Subdivision
City ^', ZIP
Phone # ( ) ..r'a?'Gt.�'l River Basin
Adj. Wtr. Body . Mu 00 `t (nat /man /unkn)
Closest Maj. Wtr. Body'
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lAgent or Applicant Printed Name
Signature Please read compliance statement on back of per lt **
Application Fee(s) Che k #
PermitOfficer's Signature
loll
IssuingDafe Expiratlo 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/ 1-888ARCOAST
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

Jun 01 09 01:27p Tony Mcneill 2523936146 �r�l p.l
r?�tY-29=2005 09:29 From:DCM MHDCIY
A
.gwa�r..r► ....w�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of (Coastal Management
Beverly Eaves Perdue, Governor James H, Gregson, Director Dee Freeman, seuetary
bate
Applicant Name 'el . "% r J / ` I l
Mailing Address / 7 eA m f: 7-7-0 O. "M
Io0 a i /tli`
X certify that I have authorized (agent) �`.� to act on my
behalf, for the pittrpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) / t,�",'. 1 '
at (location) _ bJG%4-tr S-- Cam s S;,
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] fntemet: www.nccoastalmanagement.net
An Equal Opoortunily 1Affirmative Action Employer -50% Recyd¢d 110% Post Consumer Paper

,Jun 01 09 01:28p Tony Mcneill 2523936146 p.2
±,,'PY-29-2009,09:25'From:DCM M-DCTY To:93936146 Pase:2-3
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t' that I own property adjacent to
} hereby ctr �fy p pe y }
YtVY ��
(Nasnc of Property Owner)
property located at 6
(Lnt, Block, Rosd, etc.) � L
o.n ( , in azm f N.C,. . -- - - -
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address:
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 DEW-LOPIV[EN .
(7'o befrlled in by property owner proposing development)
A4
(Information for Property Owner Applying r (Riparian Property Owner Info oration)
for Permit) . // /'/�
Mailing Address
City/State zip
'relephone Number
et `/ Vv ( p laLUX c
Print or Type Name
Telephone Number
Signature Date ( E - Date

Jun 01 09 01:28p Toni Mcneill 2523936146 p.3
MAY-29-2009,09:29'From:tlCM MHOCTY To:93936146 Page:213
ADJACENT R PARXAN PROPERTY OWNER STATTMENT
I hereby certify that I own property adjacent to 41(kc
�of :operty Oyvner)
property located at t ^ %� Z,— I
(Lot, Block, R
oad, etc.) y,f -r
on � �► S �� �l%J4L- , in C, N.C. .... _ _ .
(Waterbody) (Town andlor County)
Applicant's phone #: A�7 Imailing Address.
Re has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPT10N AND/OR DRAWING Of PROPOSED DEV LOPNII:,NT:
(To befilled in by property owner proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) ,•
Mailing Address Signature
City/State/Zip
Telephone Number
Signature Date
Print or Type Name
jib
Telephone Number
Date

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WESTERNI IMONEY INTEGRATED PAYMENTSYST MS, INC. ►SSO
UNION O RE Englewood, Color
09-106927848
AGENT03325956 DATE O62209 ? e2-40/1021
TIME09106927M LOCATION 003157 �rr"M ****
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PURCHASER'S ADDRESS l�y�
PURCHASER. SIGNER POR DRAWER
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Western Union Money Order and Design Is a service mark of Western Union Holdings, Inc./Payable at Wells Fargo Bank Grand Junction Downtown, N.A.. Grand Junction, Colorado
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