51583_NELSON, KENT_20071015

❑LAMA / 17J45REDGE & FILL
GENERAL P E R M I `r Previous permit #
❑New ❑Modification ❑Complete eissue ❑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 I SA NCAC
❑ Rules attached.
Applicant Name �, Project Location: County
Address
City
State ZIP
Phone # ( ) I Fax # ( )
Authorized Agent
❑ Cw ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑FC:
ORW:
yes / no PNA yes / no
ES" ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( )�7 �-' a `�`7 River Basin t !t • .r (.
Adj. Wtr. Body I! i �_.! l,.'%/ r�/'" nat man unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale:,,. )
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
.10
8JIL
"
tu
--
_
r
—
—
:1
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no 1
A building permit may be required by: t`1 'F'1� (
Notes/ Special Conditions
i
`
_
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date
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
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
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/ 1-888ARCOAST
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

CA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
CIII ZO
Date I - 5` / 0; OCT i X OOr
Applicant Name rl 7 Ale" Lei l S-6-YI Mo r8h%ld CjtV I)C&I
Mailing Address
I certify that I have authorized (agent) f to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 4A (,�
at (location) o
i
This certification is valid thru (date) �! U
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net

( t
�`.1 4J 1. /Ivrli, s.i .I. I'�s
i Y. �.ti t }.4.'�i•'..
ST
I hereby certify thae I own property adjacent to j � ; `�%—__� -
I }nine of s roperty Ovine")
property located at
(Lot, r3loc'c; I.oa�I, etc.)
` n
/.i
%. N.C.
7 in
on -C
("dtt_aferbocly)
ToAril acid/or Conn`) '`i %-
He has described to me as §hown bel"', the cleveloPment ]le is proposing at that loci lion,
and, I have no objections to his -proposal.
DESCRIPTION AND/OR DRA WING OF �I�
PROPO*SED DEVEL METwlT
•(To be filled in by individual proposing devc1opinent)
OCTR P FaIVED
i I aoo?
Morphookc(city DCM
---------- ---------------------------------------
ure `
Print or Type blame
Telephone Number /
r �!
Date:

ADJACENT RIPARIAN PROPERTY OWNER s,rA T EM}i+,I° T
- S
I hereby certify that I own property adjacent to -___ "' _. 1�-
(Name or Property Owner)
property located at / _��
---- --
(Lot, Block, Road, etc.)
C`
on roc Vaterbody)
�: in � 1 , N.C.
(V� (Town and/ r County)
He has described to me as shown below, the development lie is proposing at that location,
and, I have no objections to his proposal.
---------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To befilled in by individual proposing development)
v-121\ b-LA-
F9 FORWED
OCT I 1 2007
MorehQad City DCM
Signature
Print or Type Name
qlf
Telephone Number
Date: �� 5-0 6

07/04/2007 16:27 3365991823 M0HTt.k)00D PAGE 01
UVR 191-:(gcv. 11/06
C RTIF ICATE OF TITLE
VEMICLE 1DENTWK.ATt0NXUMbER'
YF4K MoVtL, MAY�E
BOr)y S-rYLE
PH.-NC127.79S*4*
.1984..PARK
MH
'unc N it
-TILE ISSUE DATE
PREVIOUS .TftLE NU MDER
778203030088045
01/11/2003
'0000011i 82 .50151
OWNER(S)NAAlii"tNb'ADDRES
7'.
DONALD KENT NELSON
7268ETHVIL HILL -SCHOOL, RD
J
ROXRURO NC :27574,- 7510.
I IN A IIIII IN 11 lal 1 IN IIIII IN 1111 IN 11101111111111
Tb(: S(afecifN'wh Carolina he y certifies ifintan iippfication t0r;4 certi(Ticafe-oftitte rbrffie h-mlit, &scribedvebiele
has been fifctf'pursuant to-ibe- 6cak, A('alialc% O'fNorth Carolina and bawd on *tbot appikation, tile Vivision of',\ . 10tor Vehic�fr; is misricd that the a . opll
1041
i3 the Iawftil owner. Ofricial reciiid.'%'orthe Division of Motor Vehicles reflect vehicke is subject to the fic'm ifany. herein enumcraictl L41 The date ofiswOil ce
.:,OF this certificate.
4ttiAndand Sea! ofthi,,% Dilvisim ofthe. day find yeir appearing in this certificate as the fillc i
'Clef
riot
OCT 1 1 2007
Morehead City L)CM
LIEN RELEASED BY:
SIGNATURE
Tint —
SECOND UENR&DEP; [SATE OF LIEN
21 LIEN RELEASED 9:
SIGNATURE
V"RD VP-,%1)49UWP: PATE OF LILA'
MN REUASED BY.
S1474"ATURE
TITLE
tQU'RT.J4 UFNHOWER: &TF, or LIEN
el LIEN RELEASED BY.
SIGNATURE
DATE—__
APOI AU UFN&.
72441228,
045 TIC0450
2007-07-04 17:34 3365991823 Page 1

07/04/2007 16:22 3365991823 MONTWOOD PAGE 01
-s^..�,'�rrr.!.ems.•+�.,+^-f^�:•..'�-';'^f::- ,..L• t�9^�
?v-'t ., „ti. ,� °'�.:}i.i::;.c,„yi ct.`;-a"•t,'a:.f S4 :.-h
IAVP, 1.91 (Acv I IR11)
:.: CERTIFICATE OF TITLE
V'EIiIC LC IDfNTif1.CATIUN tiU1,113BR YC4R MODEL MAKE BODY STYLE
PMNC12.779584 19.84 PARK NH }'•`'`
TTLE NUMBER.: T.frLE TSSUE DATF. PRf VIQV$ T1T'1., NVMBER .:.•;
O1/'11/2003 00000111825015`1
778203030088045
-#�t#,F1,��1�1�L►I�.�1't#�:aL�.i;l�#►���t����„�w{�t.�1��,i#��SI
DONALD KENT NELSON
O 726,$ET4EL HILL SCHOOL. RD
ROXBORO NC 27574-7510
V'1
OWiN$R(S) NAMEAND ADDRESS
DONALD KENT NELSON
726 BETHEL HILL SCHOOL RD
"ROXDUR'O NC. 27514-751.0
t
I All 11111111111111 IS I1111I1U 1111111111 IN 1111111111111111111111111111111
The commi55ioner ormo(or L'h,T raw orthe State oiWortit carohnx hereby certifies tivo kin aptif eado.,i tur a certificate oftitfc for the hercio dexribed vOicle '
hAs Weil filcd.pur5uxnt to the 'rcocril 5tatutcs of North Carolina anti fried an that upplicalion. lbe Dii i; of \loior I n licant . :..
i t the lau fut owner. Official rt:cotds 61'the Ui% i%iou of Motor Vehicles mileel i•ehicic
ix subj"l to the lic'.Its. if any. ha C
o'rth'is certilic ae_
1• n WTTNE55, (lis hind told sea! of lhi; Dit isicin of the tixy trod Fear appearing
y
in [)sic certificate as the tit:c i cue s` .' •: O C T 1 Y 200/7
CU, 11SSTUNER OF MOTOR VEHICLES
a oad city
ACM
1'SPST L!•Fl`IRC}L,DER t�,�TE PF i tt✓
EN RELEA5E0 BY: 1,T
51C NATU RE
DATE
SFCONU LIEN}IC)LDER: D.AT•E. OF LIEN
LIEN RUEAS), OY:
T11•LE .— --- — _ ._.;..,.... ..-.._ .---. DATE ... _..._._ r __._......._
F.
T141RO L1FNHOLDER: i2ATE Or &IF_N
LIEN Rl;(_GASED 6Y:
SIGNATURE, ._.—..._ __.:_....--_.._.�....,........:..._....., — - -
T1TLF-_-•-•--___._ -......DATE .._.,..
I"UtJItTIT C1EN1#{}GOER: UAi L UN UL?N
LIEN RELEASED BY: ,
SIGNATURE
TTTLE - - -- --..� _._.....,__ ------ _ DATE —�i- - ---
7 G 44223
1
> DQ1TiC11�1 Al LC.F'`5:
045.,T1C0450
2007-07-04
17:28 3365991823
Page 1