56049_THOMPSON, DEMUS_20100711

❑ CAMA / ❑ DREDGE & FILL �+
' GENERAL PERMIT �A P( Previous permit# w.
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue ,� Date previous permit issued
P P
As authorized by the State of North Carolina, Department of Environment and Natural Resources ,
f~ ,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -
© Rules attached.
Applicant Name ,L i 'i; i\i]v'l-� i` g z� Project Location: County
Address 1 _ ,V f d4l Street Address/j State Road/ Lot #(s)
City } 1 I i w State ZIP_1 �i' E _I � + `?
Phone # O Fax # O Subdivision
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
❑ OEA ElHHF ❑ IH ElUBA ElN/A
AEC(s):
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
City ZIP
Phone # O 7),21) Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platfo
Finge
Groin
Bulkh
Basin, channel14
Boat
Boath
Beach
Other lie,
Shore
SAV:
Sand
Mora
Phot
Waiver Attached. yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
T~ t•
The time period requirement for this
rm s
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
development is suspended until 12-31-
-
2010, pursuant to Senate Bill 831. The
Permit Officer's Signature
effective date of ex iration for this
permit is
Issuing Date
Expiration Date
y^ l
Local Planning Jurisdiction
Rover File fVani

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.
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

Applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tem im acts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

D14,CENT RIPARIAN PROPERTY OWNER STATEMENT
(FOP A PIE,'?I GORING P_ILZVGSiBOAT;rIFT,!BGATHOt SE)
i Hereby certif;i that 1 own property adjacent to
(Name of Property Owner)
r •
property located at _/_ _ . _._ .�._!` -' = _ �'-� r ` ! 4
(Lot, Block, Road, etc.) - on .4 r-J�--(-- , in N.C-
(Waterbody) (Town and/or County)
Applicant's phone #: �b'S 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. 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.)
3_ 4. 4-
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 (Riparian Property Owner Information)
for Permit) &u -'`'=- �
Mailing Address Signature
City/State/Zip rril]t or Type NamG 7—
Telephone Number D Telephone Number
ignacare Date Date

r
AAA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
n; t William G Ross .lr.. Secretary
Michael F. Easley, Governor James H. Greg -so", or
Date
of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) ` / r�-�-c�_� %mac , �� to act on my
r �
behalf, for the purpose of applying for and obtaining all CA 1A Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Il1c'�—
Property Owner Signature _
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 1 io% Post consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATE ENT
(FOR A PIER1,7111O0PING PILL NGSiBOA TLIFZT OA THO US '
I hereby certify that I own property adjacent to �� l� �C s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on inN.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Db� ' Mailing Address:
AQ� c_
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 (I T) 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
It P I do wish to waive that setback requirement.
--------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
L l�_(To be filled in by individual proposing development)
----------------------------------------- - -
(Information for Property Owner Applying
for Permit)
M�\lailing Address
{k L ,H, ►--+) L '&� C V,
City/StaieiZip
oS `Z .� S L
Telephone Number
SignacLire Date
(Riparian Property Owner Information)
Q-►��2,� .,z. C-�-+�-z la � a �O
Signature
rri]` or Type Name
y Selo- 03 S~�
Telephone Number
Date

MUD BUCKET DREDGING INC
507 HEDRICK BLVD
MOREHEAD CITY, NC 28557-3045
4445
66-112/531
Date- I O
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Pay to the --►y '� h ,2 ` Ua
Order of _ f
�� � F Feelures
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Do!laTs �"`
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT-cum
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1100000444511' is ��� �^ �•
053 10 1 2 IV0005 293 2 1831, jum
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