52312_JASTRAM, FORREST_20080624

0 CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New ❑Modification El Complete Reissue ❑Partial Reissue
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
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Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name
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Project Location: County
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Affected
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River Basin 1 �• "'
❑ OEA
AEC(s):
❑ HHF ❑ IH ❑ UBA [I N/A
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(nat. /man /unkn)
El PWS:
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Closest Maj. Wtr. Body
ORW: yes / no
PNA yes] no Crit.Hab. yes / no
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit
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Application Fee(s) Check #
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Permit Officer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction 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 (252-946-6481) 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.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax: [phone]
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

all ADJAONT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A OZERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Foe'e 5 i � �' iti1 's
(Nitme of property owner)
property located at
(Lot, block, road, etc.)
on DlVef , in N.C.
(Water body) (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. 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.
V I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filled in by individual proposing development)
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
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Print or Type Name
3e3- ci5a/ �o -
Te ephone Number and Date

ADJA%NT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A-rP.IERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to L": �'5 / ^jn-% 11,q-
(Name of property o er)
property located at
(Lot, block, road, etc.)
on %�) , in r i d "� ti a'�- N.C.
(Water body) ( own 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. 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.
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)
Z7 0o l 100 t
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
Print or Type Name
1�yC-7�n -IT51 Z �
Telephone Number and Date
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North Carolina Department of Environment Resources
Division of Coastal Management
Charles S. Jones, Director
Michael F. Easley, Governor William G. Ross, Jr. Secretary
Date
Applicant Name rc)'( ��5,�'� `Z AY,-,
Mailing Address I 1" trax� ' fl-11 t+y V LC2 LQ- AF _S (00
I certify that I have authorized (agent) Foley and Foley Contractors, Inc. to act on
my behalf for the purpose of applying for and obtaining all CAMA permits
necessary to install or construct ((activity) ,
at (location)
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] / Fax : [phone] / Internet: w%uwnccoaslalmanasement.net
An Equal Opportunity / Affirmative Action Employer
50% Recycled / 10% Post Consumer Paper

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FOLEY & FOLEY CONTRACTORS INC
MATERIAL ACCT
1810 OLD AIRPORT RD BS. 252-636-2515
NEW BERN, NC 28562-9452
PAY
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66-112/531
BHANCH 01901
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