56387_VAN MEETEREN, HANS_20100924

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT 'MV Previous permit #
❑New ❑Modification El Complete Reissue ❑Partial Reissue ,001, 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
El Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # () Fax # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
Subdivision
City
ZIP
ES ❑ PTS Phone # ( ) River Basin
❑ UBA ❑ N/A
Adj. Wtr. Body (nat./man /unkn)
Crit.Hab. yes / no Closest Maj. Wtr. Body
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:nt or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
iV
Permit Officer's Signature f
Issuing Date Expiration Date
Application Fee(s) Check # Local Planningf urisdiction
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 [)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 (9 I 0-796-7215) 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/ 1-888-4RCOAST
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

MC Division of Coastal Mgt. Habitat Impact Comk� ,"cw,
Applicant: Hans van Meeteren
Date: September 24, 2010
General Permit #: 56387C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
SB
Dredge ❑ Fill ® Both ❑ Other ❑
607
607
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
0.3
A. Signature
X ❑ Agent
o� ❑Addressee j
B. Received by (Printed Name) C. Date of Delivery
v I
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
'(Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7007 2680 0002 8365 1469
(Transfer from service label)
Ps Form 3811, February 2004 Domestic Return Receipt 00-h 102595-02-M-1540

UNITED STATES,P.p§FAE„f24�IEp:: ftrst.Cla�s Maid,.
_2ermitNa.�-Vt��M't;;.
• Sender: Please print your name, address, and ZIP+4 in this boz •
�avto if" OWST.
42-7
BOX �) 4
�ri�n-fal� NC
�7 4 111111111111111111 ifIIIIIIIII IIIIIIIIIII,I11l,III

AWACENT RIPARIAN PROPERTY OWNER grATENMWr
I hereby certify that I own property adjacent toOan`� Q"Wr4e,r,fm's
property located at
ch
alot,wool eir-)
in r� i� 1,4
1 1 ,-PaM I ICO C�)- , N.C.
(W) (Towa)
Applieanfs phone #: Mailg Address: � n'l e cks
,raTfcf 1 CC(1 -i`Lr1
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
Labe`" �
P ro p e,(4 V
DESC'RHTION ANWOR DRAWING OF morose
(To be ix bypnqpat9 orer de�laP
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(Information for Property Owner Aug
for Permit)
l0Vye' l�C
Mailing Address dL 704&
City/State/zip
Telephone Number
SignaWre Date
Prop!rtyOWUM )
Signtare
Print or Type Name
Telephone Number
�I l zo/ro
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ADJACENT RIPARIAN PROPERTY OVAU R srATZMENT
I hereby certify that I own prey adjacent to ]&i�=�
(r"e of Property Owner)
prolery located at
N.C.
l�
(Wa ) (')town county)
Applicant's phone #: MaWng Address: M e CI:}
12' ?Cf I000LAi LD
He has described to me, as shown below, the deve proposing on, and, I
Iopaa'at he is at that toc;ati
have no objections to his jai.
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cc '
OWOrmatiaa Ibr Property Owner Applying Property Owner Info )
for Permit)
Mailing Address
City/Svwzip
Telephone Number
Sign mre
Print or Type Name
Ted Number
Signature Date Date

PAY
TO THE
ORDER OF
B PRESCOTT MARINE CONSTRUCTION 2126
PO BOX 874 252-249-0149
ORIENTAL, NC 28571 /)
DATE w ss-soissi
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V ro DOLLARS 'G1Y
First Citizens fiBrstca al ens.c 5(42 3 9
FOR
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