50730_LEE, DEBRA_20080509

❑CAMA / ❑DREDGE &FILL
GENERAL PERMIT
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
I^
Project Location: County
' 1 ` �.„� ",
Address
Street Address/ State Road/ Lot #(s)
City State . ZIP
Phone #`' ✓--'F.-` Fax # O
Subdivision ,
Authorized Agent — —" ` �- . —�-
City ZIP
Affected ❑ CW ❑ EW '❑ PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ Pws: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes no
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit,
Application Fee(s) Check #
PermitOfficer'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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
9 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 ru es.
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

-ROM
( U=)MAY 6 2008 13:44/ST- A:43/No, 6807923065 P 1
Pamlico County
Environmental Health Department
PO Box 306
Bayboro, NC 28515
To:
Company:
Fax Number:
From,
Department:
Date -
Total Number of Pages
Subject: ffi.,
Message -
Fax Cover Sheet
ding cover page):
Confiden.tialzty Statewent: This faxed transmission contauts infUmatiotl that's confidential
and is intended for the use of the individual far the agency nanaed on this cover sheet, Xf you
are not the i:ateiaded recipient, you are informed that any disclosure, copying, distribution, or
a the talking of any action is reliance on the contents is strictly proaibiteand the documents
should be re- rumed to this agency immediately.
If yoU do not receive all the pages or have difficulty reading this fax,
please contact Vanessa Hackney at 252145-5634,
Enviroamental Health [phone] Fax [phone]

(-U=) MAY 6 2008 13: 44/ST, ' 3:43/No, 6807923065 P 2
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
MidW F. Easley, Governor James H- Gmgson, Dimctor Willan G. R= Jr.. Se=Wy
Date
Applicant Name 2A)by-6- A - Lei
Mailing Address 4l t��11s
�r,ro�r� s 1�opw IBC. =.y5 �°1
t certify that I have authorized (agent f7 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
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install or construct (activity) _
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at (location)
This certification is valid thru (date) z//
Signature iZJe �• --'S"�-'�
4DD Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www,ri=astalmanagement.net
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(-UDMAY 6 2008 13:44/ST. ' 3:43%No, 6807923065 P 3
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PS Form 3811, February 2004 Domwo-_
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U-)M0 5 2008 13:44/ST•'3:43%No.6807923065 P 4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIFRIMOORDVG PH"GSIBOA TUFFIBOA THOUSE)
l ?
I hereby certify that I own property adjacent to � 1—ef—�
(Name of Property Owner)
property located at 91 co OdCue-115 FW4.
(LA, Block, Road, etc.)
on i r85 Crecy) , in m , / 91M l l ro V.C,
(Waterbody) (Town and/or County)
He has described to me, asshown 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 (151 from my area of riparian access unless
waived by me. (if you wish to waive the setback, you must initial the appropriate blank
below.)
1 do m¢t wish to waive:
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(fe be,fdied in by individual proposing development)
V
V t 4 v
-4/ W W V/ \/
Date:
Signature
Print or Type Name
Telephone Number

(-U=)MAY 6 2008 13:45/ST. ' 3:43/No. 6807923065 P 5
ADJACENT RI PARiAN PROPERTY OWNER STATEMENT
(FOX A PIERIMOOWNVGPILIIVGSIBOATLIFTIROATHOUSE)
I hereby certify that I own property adjacent tz" tee° 's
(Name of Property Owner)
property located at �(/G A144" CR" -
(Lat, Block, Road, etc.)
ons L in �� �.'��/ '� N.C.
(Waterbody) otown and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, 1
have no objections to his proposal. I understand that a pier/mooring pilings 1 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 mast initial the appropriate blank
below..)
V 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)
Signature
] �J Print or Type Name
Telephone Number
al�Date: R'�

'—U=)W 6 2008 13:45/ST. ' 3:43%No. 6807923055 P 6
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DEBRA A. LEE
3855
252-249-7236
416 HOWELLS ROAD531
GRANTSBORO,NC 28529
p
Date S - b O 66-30/290
Pay to th e
Order of_ C �E N�
$ Q
First Citizens
Bank
firstcitizens.com
ForSAPa1 L--t"m1'j
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03855
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