51121_POILLON, RICH_20080530

❑ CAMA / ❑ DREDGE & FILL 12
QENERAL PERMIT 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 Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name
Address
City
State
ZIP
Phone # ()
Fax ()
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES
❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no
Crit.Hab. yes / nc
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nnt /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 1
Boathouse/ Boatlift
Beach Bulldozing
Other
i
j
I
r
-
--
-
—
1
-
i
i
Shoreline Length [
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no.
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: ?
Notes/ Special Conditions
i
_
I
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit Officer'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, 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/ 1-888-4RCOAST
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

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor ,James N. Gregson, Director rr,? ep
Date H' ( S - 0�
MAY 1 6 2008
WrOpfio C0 CAN
Applicant. Name �t
Mailing Address C)<g J,�Lo�,"— � ►��'
2
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAINIA Permits necessary to
install or construct (activity)
at (location) "1 �� _J� (-t.� ✓ 2�
This certification is valid thru (date)
Signature 14c,< � y�
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

01/10/2000 11:U9 919-787-9ee8 WNTKINS PAGE 01
C' ................
PMAY �� 6 2008
AGEMores eau city ocm
ADJACENT 1UPARIAN PROPERTY OWNER STATEMENT
(FOR A M"OOJUNG PIUNGS/BOATLIFT/BOA7H®G'SE)
I hereby certify that I own proptrty adjacent to X + L.K&' 0 .D � w.- 's
�[[` (Name of Property Oweer)
mpeoy located at i _.. #� r 0-14
(I,ot. Bieck, Road, etc.)
Aferbody) (Iowa 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 PmPO 1. I understand that s pier/mooring pi tingwboatlift/boathou9e
must be net back a minimum distance of fit'teen feet (.I S') from my area of riparian acvcss Qnless
waivedEby me.
i &Q pot wish to waive the setback requirement.
✓ 149 wish to waivc that setback requirement.
_-----------------------..------------------------
DESCRIPTION ,AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be JUkd in by lwdty uW propplhq *W10pmeat)
fx,s-HNs
(Appheiot tafora+allon)
Mailing'4fi*em
t:'iry�Sicrcr('�Ip
TekphoAl lWember v q
0 0
(Itiparies Property Owner information)
ttre
Prim or Tvpr Name
Ts Nwober
(,)we

(A Z5 2-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(gOR A PIER/MOOR.ING PILINGS✓BOATLIFTBOATHOtISE
C
), F9 a) W;
hereby certify that I own property adjacent to ► �K �j a rJB
(Name of Property Owner)
propert� located at -[ O i`i 1� ► ►-r5 ►c b v ,
(Lot, Block, Road, etc.)
on vT- 1 Q- a _ o- � in 1-,e ..� -� %c d3 l✓f , N.C.
aterbody) ('Town and/or County)
"c has described to me, as shown below, the development he is proposing at that location,
and, i hive no objections to his proposal. I understand that a pier/mooring pilings/boatlifl/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 AINDIOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developnwnt)
*� ALL
C`!.' 5 44P4.5
t Information)
'PIZ), �I 0•-*
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13€ V-L h N .0 ,
Telephone Number
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Date
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(Riparian Property Owner Information)
signdure
Fl, Ali�`t,` ut"�SK�—�`S
Print or 11,pe lame
C,C-(S-2•-3sV�
Tekphone Number
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Date \

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MUD BUCKET DREDGING, INC. 301266-112/531
PH. 252-241-1504 BRANCH 02201
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557 ,
DATE
TO THE
ORDER OF
`., I _ , r_..__.. _ DOLLARS
B�
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.00m
n NIP
FOR
u'0000 30 L 211' i:0 5 3 L0 L L 2 Li:000 5 29 3 2 L8 34 LII'