51543_POLOWY, CLARA_20071108

❑ CAMA / ❑ DREDGE & FILL x' [
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name .`f uuo °!i ( �,t .t -� i. V4 V Project Location: County
Address - ��tµ+_ f --� Street Address/ State Road/ Lot #(s)
City t �A State %.0 ZIP
Phone # O ` Fax # (`) Subdivision
Authorized Agent i City ZIP
Affected D CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): OEA HHF ❑ IH El USA ❑ N/A Adj. Wtr. Body L. a gnat /man /unkn)
El PWS: El 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 #
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
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

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I hcfebY certify that I own property adjacent to % L A 9A �„ 0 �1 V Ia
ttveme of Property Owner)
Pam!+ locam sS 5 L a' C c�P,� T.o L ` e ",, Je-
(LOt, BWAI Road; etc,) s
on 20 G ve So u ND , in c�`MCKA L-
- die r = ddftamd iv me as dx)wn below, made e?0nmeQt he ;&
and, T no objecdons to IiS �^:opCu%,
DESCIMMON AWOR I3Rwvri�RRING OF Pkop )om Dvv ter,0 ►rr
(To be filled in by imlivfdud proposing deydlopimm)
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Print or Type Name
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AWA%',I (-r RwA� i A N -PRoP 'Tpa V O ' 1. SrAirrivii'�:� l
I hemeby certify that I own property adia mt to l6- A RA ;%
tName of 1'�Y Owner)
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(Lot, Block, Road, etc,)
on 30 ! 416 So U N1) , in 0/t+4- 0 f � C t= , ?4. C.
MSterbQciy) (Town ar-W or County)
itm AS 9il0WTI bdOtiV; dbe [ytlmmt Iv. is rev uaii� ai ttiai !'GL'dt`14I1,
and, I baw no ob,;--drns t fiz propo—,.
'3E.erCI—I'MIM-4 AND/OR i�Rp►i�vrSG �iF PRoM nE 'T.�.� ^�ti':
(To ba,/illed in by ivt�daal propvaiag development)
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Signature
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Pant or Type Name
727- S3.
Telephone Number
Daft:

ADJACENT REPARIAN ]PROPERTY O'l�ER STATEMNT
I hereby certify that I own property adjacent to K1 C, r Ci Pa )a ( 's
(Name of Property Owner)
property located at S Li Ce d C, r -",. r ,L, N e
(Lot, Block, Road, etc.) / '
on o LN ,in tfy' �'ra / T / 5 N
aterbody) (T, N. C.
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.
DESCRIPTION AND/OR DRAWING 0E- PROPOSED DEVELOPMENT
(To be filled it' by individual proposing development)
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Signature
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Print or Type Name
Telephone Number _
Date: % +'
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NOTE: Approx. Mean
High water Line
VICINITY MAP
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(Not to Scale)
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TOTAL LOT AREA
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Ex. 249' Pipe
16,084 Sq. Ft.
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(Coord. Method)
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Zone X (Shaded)
Approx. Flood Zone Lines
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NOT FOR RECORDING
P.I.N.: 6304. 18 42 21 14 _
FLOOD ZONE: As Shown (7-16-03)
Per Firm 370047 6304 J 8 Flood Insurance Study �t T 3 j 2�07
SUED. REC.: July 1971
40 20 0 40 80
GRAPHIC SCALE -- FEET
I, Pate D. Phillips, hereby certify that this map is correct
and prepared according to the Standards of Practice for Land
Surveying in Carolina and that (there are no
encroochrr it either on_ -aid survey,
Pate cII,--Tfiif195, ' PLS No. 2640
Ratio of Precision — 1 i 10,000+
�FESS10
4 SEAL
y L-2640 <�-
0
Morehead r ty DCM
SURVEY FOR
KLARA LA UER POL O FY
Emerald Isle REFERENCE: Lot 26 Block
Carteret County 22—A "EMERALD ISLE BY
North Carolina THE SEA" Map Book 8 Page
59 Carteret County
Scale I" = 40' Registry
September 13, 2007
BELL & PHILLIPS SURVEYING, PLLC
604E Cedar Pt. Blvd.
Cedar Point North Carolina
( 252 )393-6 101 Pr o J ec t No. C 06492
SF 06492A

ANN G. WILLIAMS 11-01
NCDL 5275849
5502 FREDEEN CT. 252-3543641
EMERALD ISLE, NC 28594-3521
to
1638
65-191530 NC
Date
j C% 77 2002
fy
'�'^ Dollars
BankofAmerica
ACH p/T 053000796
Memo
i:0 5 3000 19 6i: 000 6 900 3 L00 7u' i 6 38 - '` ---