53665_WILLIAMS, JACK & SUSAN_20090601

LCAMA / ❑ DREDGE & FILL C
GENERAL PERMIT V/ Previous permit#
El New ❑Modification ❑Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Res urces
I
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
7 Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
Phone # ( )
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ( ZIP
Fax #
❑ EW ❑ PTA r7 ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
FC:
PNA yes / no Crit.Hab. yes / no
Subdivision
City ZIP
Phone # ( ) River Basin ,
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body ii i .
Type of Project/ Activity
(Scale: f )
Pier (dock) length
Platform(s)_
Finger s
pier(s)
Groin length
number
Bulkhead/ Riprap length^'
avg distance offshore
max distance offshore r
Basin, channel
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: es y no
A building permit may be required by:
Notes/ Special Conditions
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❑ See note
on back regarding
River Basin
/
Agent or A plicant Printed Name ✓
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Signature Please read compliance statement on back of permit
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Application Fee(s) Check #
PermitOfficer's Signature
f
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, 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/ I-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

NOE CONSTRUCTION & SERVICES, INC. 1202
P. O. BOX 2012 PHONE: [phone]
BEAUFORT, NC 28516 66-1246/531
Date
w Pay tthe
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Beaufort, NC 28516 `
For 1-7� f 7 ,-- -L-.� F -- -- Nr
1:0531 L 2L.66i: 00077099,15 1202

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. ,lodes, Director William G. Ross Jr., Secretary
Bate J ��
Applicant Name
Mailing Address G r CJ� ►�
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I certify that I have authorized (agent)
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behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
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This certification is valid thru;- late)
Signature
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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

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
(N/ame of Property Owner)
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p (Lot, Block, Road, etc.)
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(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to vet' aii(�J' I/e�s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.) f ,L
on CL�� �•�� 1e '�' , in
(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
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Mailing Address
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City/State/Zip
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Telephone Number
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