52340_NELSON, HARVEY_20080707

❑CAMA /,❑ DREDGE & FILL "D - )2"3
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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 -� r
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ,f` •fit --
❑ Rules attached.
Applicant Name ` P L C
Address
State
Phone # (�) Fax # ( )
Authorized Agent
Affected
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AEC(s):
EJ OEA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW:
yes / no PNA yes / no
ZIP_
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
roiect ocation. ounty
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier ..
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Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Issuing Date
Application Fee(s) Check # Local PlanningJurisdiction
Expiration Date
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
Iandowner(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 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/ 1-888-4RCOAST
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

10 'd 09zZKLn8 'ON XVd SN iAON001 100 Wd IS;SO INd 80H-LMAF

JUN-27-2008 FRI 03:31 PM CAPE LOOKOUT NS FAX NO. 2627282250 P. 02
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit: lea f V u Al' f 1 I5 C h
Address of Property: 3 (l r) a q U r e [u f , Pa C L(V s _T� ) rl
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(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this letter.
� have no objections to this proposal.
if you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
10 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
WAIVER SECTION
rry�;
4
JUN 9 2008
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags ,..'y ®CM
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Applicant Information)
--'3U r C�/�,
\�ailing Address
c{rk-er- i -J � I vtd
City/State/Zip
Telephone Number
Date
(Riparian Property O er Information)
Signature -
Print or Type Name
Telephone Number
Date

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IGNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
,USPS '
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
a � v le y Al-e- 15on
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III tFf!)IitI11'iI;III II;III ;lIII
■ Complete items 1, 2, dnd 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:
3 rc� i 6n? n Soh
eS 51 d e' Ci rcip—
�,Sheboro IVC
9
A.
by (Printed Name) I C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. ySen��ype
�- ✓_=%
L� Certified Mail�❑
❑ Registered
Express Mail
LeJTieturn Receipt for Merchandises
❑ Insured Mail
❑ C.O.D.
4. Restricted Delivery? (Extra Fee) YPR
2. Article "
(rranst 7007 3020 0001 6975 3059
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
U.S.
Postal
Service,.
CERTIFIED
MAIL,.
RECEIPT
(Domestic
Mail
Only;
No Insurance
Coverage
Provided)
For delivery
Information
visit our
website at
www.0 P
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ul
Q' Postage $
- Certified Fee T1 e
C3 Return Receipt Fee (J tmark
ED (Endorsement Required) p�lera
"testlicted Delivery Fee
Q seme (Endornt Required) e
ru d(¢
C:3 Total Postage & Fees
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p Street, Apt. No
lti or PO Box No.
C/ry, State. ZIP+4-----------""

.05/17/2008, 13:47 1-336-629-0396 BRANCO PACE 01/02
CERTIFIED MAIL •RETURN RECEIPT JaM.EATED
DMaNClN OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIQNiWAP/ER FORM
Naas of Individual applying for Permit~ Wy- �i f1 -C o in t
Address of Property: 0 _
.._ �. 5 3 f
(Lot or Street #, Street or Road, City & County)
i hereby certif!► Tmt I own property adjacent to the above referenced property. The individual
appd)ring for this permit has described to me as shown on the attached drawing the development
they are proposi A description or drawing, with dimensions, should be provided with this letter.
' l have no objections to this proposal.
If you have objections to what is being ,proposed, pkase wrJte dw Division of Coastal
URn-agemer4 4W Commerce Avenues Morehead fifty, NC., 26557 orWi (252) 08-2M w-Ahin
10 drys of receipt ofthis nodm No response is considered Me same u no objection p you
hwA,bom notified ft CedWed Anil,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatiift or sandbags
must be set back a mirrimurn distance of 15' from my area of ripwian access unless waived by
me. Of you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
1 do not wish to Waive the 15' setback requirement.
(Applicant Infomriation)
Mallllt�l Ac�rsss
cityloStateMp
Tewhorre Number
p0 p
Dire
(Riparian
Information)
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lc> -571-Z8`-'f
Tek,�phone Number
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JUN 9 Z008
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F5117/2008. 13:47.. 1-336-629-0396
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HARVEY A. NELSON .L 4611
Brenda G. Nelson NCDL 714413
SSN 246-02-7316 SSN 246-02-5844 66-21/530
309 Bayview Dr 252-728-3827 BRANCH 77585
Harkers Island, NC 28531 '4% — CI Q
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$ &on
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Wachowa Bank. N A
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1:0 30002191:10S468114S64pm 4611

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