54120_TYSON, JEANNIE_20090602

J CAMA / ❑ DREDGE & FILL .
GENERAL PERMIT U Previous permit#
❑New ❑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
❑ Rules attached.
Applicant Name
Aridracc
City State ZIP
Phone # O Fax # O
Authorized Agent
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)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nai /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
i
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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, 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 (252-946-648 I) 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
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/ I-888-4RCOAST
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

66-7162/2531 2089
CHARLES F TYSON, JR. 5000555325
4507 WEST FAIRWAY DR.
NEW BERN, NC 28562 DATE
PA}' TO THE s 2, 6)
ORDER OF /v� f 1
l / ✓ �' DOLLARS
Senior
First ,South Bank Checking
NEW BERN, NC 285 2208 'y1 r/� 1 r j"i
MEMO `S t 0 0C Off/ v , M'
�:2531?16 0: 5000555325ii' 02089

APR-27-2009 08:54 From:DCM MHDCTY To:96330024 Paee:1,'2
ADJACENT RIPARIAN PROPERTY ; R STATEMENT
(FOR A PIEII/h100AIIVGPILliYGS 00,4TLIF BOATIIOLSE)
Ste-,
1 hereby certify that I own property adjacent to CA
(Name of Property Owner)
property located at rz nA'Q RA Q -
(Lot, Block, Road, etc,)
on N.C.
(Waterbody) (Town and/or County)
Z 5 IN (A-( v�.
Applicant's phone #:25 3 "�%�� Mailing Address: 7
r •�j �il � �— C z� s (o �
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 tnuurnum distance of tifteetl feet (1.5') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank rt--y
below.) ri
I do not wish to waive f�AY 2 6 2009
I do wish to waive that setback requirement.
w- _ it
DESClt1 TION A.NWOR DRAWING OF PROPOSED DEVELOPMENT:
('To be filled in by individual proposing development)
1 l V v mod
6
------ ------------
(Information for Property Owner Applying (Riparian Property Owner Information)
fur Permit)
V5_0? w.0,t -�1,VwAl
Mailing Address /
i
0 S,
City/State/Zip
Signature
�^ Print or Type Name
Telephone Number
51�P/ <1
Date

APR-2772009 08:54 From:DCM MHDCTY To:96330024 Page:2'2
e
ADJACENT RIPARIAIN PROPIE" X OWNFR STATEMENT
(FOR A PIERIMOORING PILINGS OztTLIFT BOATHOUSE)
I T,
I hereby certify that I own property adjacent to
(Name of Property O nerj
I
property located at
(Lot, Block, Road, etc.)
on f V C� t �- �-� , in
(Waterbody)
Applicant's phone #:
C,fLj4�- V-e,
I DU
(Town and/or County)
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 uriless
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 reguircrricnt,
_____ - - -
DESCRIPTION AND/OR DRAWING OF PROPOSED DFVFL0PMFNT:
(To be filled in by individual proposing development)
Tt=
LA N wC
6 6, -�
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-----------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address, Si(gnaturc
City/State/Zip _ Print or 'Type Name
�Sz- �37�d813
Telephone Numbcr
Date