53029_THOMAS, WALTER_20081124

❑ CAMA / ❑DREDGE &FILL
permit #
GENERALAL PERMIT Previous
❑New ❑Modification EJComplete 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
[ Rules attached.
Applicant Name Project Location: County____---_
Address— Street Address/ State Road/ Lot #(s)__
State ZIP
Phone # (`) Fax # O Subdivision
Authorized Agent_ City __ ZIP
Q CW ❑ EW [ PTA ES I j PTS Phone # ( ) River Basin VJ;,
Affected
[ ❑ PWS: ❑ FC: OEA 7 HHF ❑ IH UBA ❑ N/A /"�
AEC(s): Adj. Wtr. Body_------- a na ma unkn
� r
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body fit. J1C
Type of Project/ Activity
Pier (dock) length
Platform(s) — , `- { - —i 1--
Finger pier(s)
Groin length
number_" -
Bulkhead/ Riprap length�-
avg distance offshore I �— -_
max distance offshore — —I-
-j--- I
Basin, channel
-' -- - --- J
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other___
Shoreline Length
SAV: not sure yes no
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
AoApplicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale:
See note on back regarding River Basin rules.
Permit Officer''s Signature
Issuing Date +++ ExpirationDat
� f Al)�
Local Planning Jurisdiction Rover File Name
)I

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 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/ 1-888-4RCOAST
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 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

ALTG-31�awA
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 3 (?
Name of Property Owner Applying for Permit:
r. .
Mailing Address:
H(s, ijG. 0-�K5(�@'-
I certify that I have authorized (agent) fn �^ � v k � to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) -S� R w t4 t ( I
at (my property located at) l 1� u !T� 13 o r-C) i T&�>'i? S - j L,
This certification is valid thru (date)
Property Owner Signature
1l o
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to L)J A IT 1—:: >Z-Th 's
(Name of Property Owner)
property located at Q bo x-- V , 4 6— D r.
(Lot, Block, Road, etc.)
on C '"'a L-, , in i`5 (`% '� , N.C.
(Waterbody) (Town and/or County)
He has described to^Ine, as shown below, the development he is proposing at that location,
and, I have no objections to tits=proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimumfdstance of fifteen feet (15') from my area of riparian access unless
waived by me.
L:
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ff ,14() � r
o t d U-f 01, k-_
(Applicant Information) (Riparian Pr rty n r Information)
Mailing Address
.P KS ,
City/State/Zip
Telephone Number
. 2- 5 g
Date
Signature V
<-�
Print or Type Name
Telephone Numb r
�l
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORIIVG PIL17VGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to �J�-cG�✓w�� 's
(Name of Property Owner)
property located at L& boy-U t'� lD 3'
(Lot, Block, Road, etc.)
on in i i L �� l/2c�Y `� , N.C.
(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 tip proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum;4istance of fifteen feet (15') from my area of riparian access unless
waived by me.
'r-
I do not wish to waive the setback requirement.
I do wish to waive,that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
L-L- o 6 S k o,zzG (., a a- >�
!✓��vSvrZ�
(Applican
t
Information)
Mailing Address
City/State/Zip
Telephone Number
Z3 u $
(Riparian Property Owner Information)
Signature
(>
Print or Type Name
z 52- - Z L%& - 2 //y
Telephone Number
Date Date

DIANE L THOMAS
108 AR90RVITAE DR
PINE KNOLL SHORES, NC 28512
1 (_1231,- --� DATE
0121
66-35/531
/ s�FAY TO � C7'
��IIOLIA'll
(/ Premiere Money Market
W� GWachuvia Bank N.A.
Morehead Gty, N 28557 ✓ �� /J
FOR 11 (
1:053L00355�: 0458 L935991I■ OL2L
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