51525_SHIELDS, WRIGHT_20071001

1� CAMA / ❑ DREDGE & FILL
GENERAL PERMIT 00
❑New ❑Modification ❑Complete Reissue El Partial Reissue
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
Applicant Name s =>
Address
City State ZIP ~ 1
Phone # O Fax # ( )
Authorized Agent
Affected ❑ cW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Previ s permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
0 Rules attached.
City ZIP
Phone # (�) River Basin
Adj. Wtr. Body i ti, t (nat /man /unkn)
Closest Maj. Wtr. Body '� V t i
Type of Project/ Activity
(Scale: n �' )
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
i
1
i
At-
i
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no i.
Moratorium: n/a yes no ;
Photos: yes no I_ .�
Waiver Attached: yes no
A building permit may be required by: ! `�" f� - ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
r;
Signature Please read compliance statement on back of permit
'3-
s
Application Fee(s) Check #
PermitOfficer'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, certifythatthis 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/ 1-888ARCOAST
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
910-796-72I5
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

A�A.
NCDENR
North Carolina Department of Environment and Natura
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director
Date 5 rpT G '6 , -z -I
Resources
William G. Ross Jr., secretary
Applicant Name �� 21(Ll�I- Ate► � Y\i���ASZ� s �1-� � Z s��
,N4ailing Address 2 3""'t-7 Ct-4 1 '--1 QyApvti 2Q P�s�
N —=: 2-50, S(, Z
I certify that I have authorized (agent) I -1An c. t C.� .' Cl S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) 23`f 7 &
This certification is valid thru (date) loll L 7
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to JJ2lC44T AO-�'D 1AAMC4 At�s -t tc
(Name of Property Owner)
property located at Z34
(Lot, Block, Road, etc.)
on , in ti1 N.C.
(Waterbody) (Town 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 / 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 must initial the appropriate blank
below.)
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)
----------------------------------- ------------------------------------
,, II Signature
1�41�rJC�( C{ lt�U S
Print or Type Name
Telephone Number
Date: k2c,,-S-r- 2007

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Awc) MAfU) A-2z7 Skk'!f&D s
(Name of Propertv Owner)
property located at Z 31 -1 C-u 1 N 0.y Ali � V-'z'
(Lot, Block, Road, etc.)
on ``�`2 �r TZ •,I , in . N.C.
(Waterbody) (Town 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 OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
I N
Print or Type Name
a - (0 oa
Telephone Number
Date: 7

Ie1t WA MILLER HILDS 7688
2351 Chinquapin Rd Ph 252-638-2045 66-211530
New Bern, NC 28562 BRANCH 77513
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Pay to the _ �
order of ` �5' as
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Dollars
WACHOVIA
Wachovia Bank, N.A.
wachov�, E) '
For e;)SC
':0530002 L9i: L054666 j797601i' 7688