55226_TAYLOR, BILL_20100120

CiCAMA J DREDGE & FILL
GEN12ERAL PERMIT /Zl/Previous permit#
QNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
0 Rules attached.
Applicant Name
) 4�3 r;.r
Project Location: County ~
t? Jo 1"
Address c' L ! I' p T-
Street Address/ State Road/ Lot #(s)
City � ;} o -J
�7 t f n State N(. ZIP ' jb' 6 2
")f
Phone # O
5-)- t Fax # O
Subdivision
Authorized Agent
`P Ob. kI ; L C
fla � � .i . U r .
City _� � �,,.� .-z1t ,�
ZIP
ElCW
❑ EW PTA ElES OPTS
Phone # ( Z 5 Z
River Basin ��� U 1 C
Affected
ElOEA
AEC(s):
❑ HHF ElIH ElUBA ❑ N/A
Adj. Wtr. Body -; -
(nat /man /unkn)
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Agent or Applicant Printed Name Permit Officer's Signature
Signature Please read compliance statement on back of permit" Issuing Date Expiration Date
ApplicationFee(s) Check# Local PlanningJurisdiction 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, certifythatthis 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 rced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252- -6 t)-4a 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 Citv 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

Appendix A
Adjacent Riparian Property Owners Statement
(for a bulkhead, dock/mooring pilings)
I hereby certify that I own property adjacent to
(Name of property owner)
property located at 5 ey
(Lot, Block, Road, etc.)
on /2, is r �C NC in �f/�"u/ %s',�-ii ,
Waterbod
( y) (Town and/or County)
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 dock/mooring
pilings must be set back a minimum distance of fifteen feet (15') from my area of riparian
access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
Description and drawing of proposed development:
(To be filled in by individual proposing development)
5'-0. 14'-0"
51x12' Walkwa 721
M
Z LZ
Z(, / 1
t--- Z
Sign e
Print name Date
�S % - �3zS
Address Telephone number
A-2

G
^r.
Appendix A
Adjacent Riparian Property Owners Statement
(for a bulkhead, dock/mooring pilings)
I hereby certify that I own property adjacent to f; l ll
(Name of property owner)
property located at 5e44 gyp./%i /-
(Lot, Block, Road, etc.)
in NC
(Waterbody) (Town and/or County)
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 dock/mooring
pilings must be set back a minimum distance of fifteen feet (15') from my area of riparian
access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
.I
Description and drawing of proposed development:
(To be filled in by individual proposing development)
5'-0" 14'-0"
J1911rilure
Print name
jD9 L1 t2 OL7V l�7E
Address
A-2
iz jzc;lo
Date
Telephone number

AG'A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date (Z,' Oq
Applicant Name L LI
Mailing Address t5btl
Imo( t C? -T-1Q 1�' i Z�� 2
I certify that I have authorized (agent) ' Iy l/ OLi&:f7! LL6- 0 act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
(activity) '�� i,l SIC
install or construct activi OLD l�x�l�(,�! C.TZo ,
at (location)
This certification.is valid thru (date) 12 f �� Igo
Signature -�
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
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