52608_SIMS, DEREK_20080912

❑CAMA / �7, DREDGE & FILL (q 159-6�/ 15.6
GENERAL PERMIT �/�/110-0 P ev s ermi #
[]New ClModification ❑Complete Reissue ❑Partial Resue '�/ �J 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 15A NCAC
❑ Rules attached.
Applicant Name )Icl ± �4-- Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
State ZIP , -
Phone # ( )
Fax # ( )
Authorized Agent
t
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
ElOEA
AEC(s):
ElHHF ElIH ElUBA ElN/A
❑ PWS:
❑ FC:
ORW: yes / no .
PNA yes / no Crit.Hab. yes / no
Subdivision
City i 1<: �'' ZIP . , o C3
Phone # ( ) River Basin s -'
Adj. Wtr. Body oCtt vrt t_ et_ ' (nat /man unkn
Closest Maj. Wtr. Body
Type of Project/ Activity /
(Scale: )
Pier (dock) length X a i
Platform(s)
Fingerpier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore o
Basin, channel t Z
cubic yards t} -.Lj
Boat ramp-
Boathouse/ Boatlift ' '1470
Beach Bulldozing
Other
-
I IT
—
i
-
-
----
- -
—
-
-
—
-
-
I
Shoreline Length 0
SAV: not sure yes no>
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no !
Waiver Attached: yes no - —
i'
A building permit may be required by: f' © See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
7 y -Z
Application Fee(s) Check #
_ Ix ,
,,Permit Officer's Signature
�1 • Z-C,�-,) 1 -
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 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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

North Carolina Department of Environment Resources
Division of.Coastal Management
Charles & Jones, Director
Michael F. Easley, Governor William Q. Ross Jr., Secretary
natP
G

09/03/2008 13: 6 2524479900 FIRST WOLINA PAGE 01/01
A,I)JA XT RWAR ALN j'ROPERTX OWNER STATENMNT
(FOR AVWRM0 RIJVG PH-LY OATLIFTlBOAT'YOUSE)
I liexe'oy certify that I own property adj scent �y a°
(Ng a of props owner)
property located at �. "`
(LAt, block, goad, etc.)
Of � � N.C.
. (Water body) (Town and/or county)
He has described to me, as Shawn below, the denloPment he iS proposing at that
location, and, I have no objections to his Proposal, t understand that a pier/Mo0 ing
pilings/boatlitilboathouse must be set back a 4ninimuna distance of fifteen feet 0 5') &vm
MY area of ripwian access unless waived by =-
I do riot wish to waive the setback revirenment.
I do wish to waive
t setback maiuiremen
(fA
� As tOR. ?RA�V G OF PROPOSED DEVELOPMENT:
beflikd In by uaj pmpo4mg elopment)
Foley & Foley ConftwtOrs, Inc.
Phone#: [phone]
Fax#: [phone]
Suture
Prins or lTyy`p/e N e
Telephone Number and Rafe

ADJAONT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A TRIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to IWAro
m(Na a of prope owner)
property located at d�� N �.:,li S . hia ,/wit . ,
(Lot, block, road, etc.)
ons%C' oo M CJ24W
< in _¢ AJ?f 4G&<< A1.0 • N.C.
(Water body) (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. 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.
I do not wish to waive the setback requirement.
I do wish to waive t setback requirement.
DESCRIPTIOI' AND/OR7*ividualproposing
G OF PROPOSED DEVELOPMENT:
(to be filled in development) '
Foley & Foley Contractors, Inc.
Phone#: [phone]
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ADJNT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A i ,1ERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent toi2Z&w Jk-r
(Na a of proper owner)
property located at " e�.� •.� ti S • �/Z �it
(Lot, block, road, etc.)
ons000W.. 4�RR/� in 9ti��73�ur�l� �-� • , N.C.
(Water body) (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. 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.
I do not wish to waive the setback requirement.
Y I do wish to waive t setback requirement.
DESCRIPTION AND/OR DRAW G OF PROPOSED DEVELOPMENT:
(to be filled in by i vidual proposing development)
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
gnature
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Tint or Type Name
Telephone Number and Date

0(caQ
r-7 FOLEY & FOLEY CONTRACTORS, INC.
PH. 252-636-2515
1810 OLD AIRPORT RD.
NEW BERN, NC 28562
TO THE
PAY `/
ORDER OF__! ✓ C_
Flrst South .Bank
/�� NEW /BERN, NC 28562-5208
FOR &#engrU�.S/r11-' �/4
"'0000 1 2 9 2u' 1: 2 5 3 1 7 16 2 0:
1292
66-7162/2531
DATE 1Z r0�
DOLLARS 8
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680073691711■