51136_SPARKS, NICHOLAS_20080606

171CAMA / ❑ DREDGE & FILL '% 14,
GENERAL PERMIT L1/
❑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 15A NCAC_
Previous permit #
Date previous permit issued,
❑ Rules attached.
Applicant Name Project Location: County
Address = �� ' Street Address/ State Road/ Lot #(s) i ^'
City State L- ZIP,' p
51.136
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Phone # O . i :5`r. Fax # (,) Subdivision
Authorized Agent City 1' �� > f ZIP
Affected ❑ Cw ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # O River Basin
AEC(s): ElOEA 1-1HHF ElIH ElUBA El N/A Adj. Wtr. Body 1 t ; ~1 �. ' `'� ` (nat /man /unkn)
ElPWS: [IFC:
ORW: yes / no PNA yes / no , Crit.Hab. yes / no
Closest Maj. Wtr. Body —� K
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
f-�
ermitOfficer's Signature
6
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:
X 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

North Carolina Department of Environment Resources
Division of Coastal Management
Charles S. Jones, Director
Michael F. Easley, Governor William G. Ross, Jr. Secretary
Date RA
Applicant Name
Mailing Address
I certify that I have authorized (agent) Foley and Foley Contractors, Inc. to act on
my behalf for the purpose of applying for and obtaining all CAMA permits
necessary to install or construct ((activity) N �,;,1 o _;� 'Nr ,
at (location) r \\j t G
This certification is valid thru
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] / Fax : [phone] / Internet: vvwtiv.nccoastalmanaRement.net
An Equal Opportunity / Affirmative Action Employer
50% Recycled / 10% Post Consumer Paper

ADJ NT RIPARIAN PROPERTY. OMFNER STATEMENT
(lR#/MaDRING PIiING,S`i/BIATI?/BOATSXiFTEJ.
�. I hereby cer* :that I own property adjacent to.
of prq . eirty owner)
property located at Q Z.. U:Qs yi
(Lot, block ..road, etc.)
(Water body) (Town and/or county)
He has described -to. me, as ghown-beiow, the .4evelopment he is itrg:a drat
1 lion an I have no objections to his proposal.. I understand that pier coring
ilia oathouse must ber.set back a minimum 'distance of fi#%en feet (15'): from .
my area of rivarian access unless waived by me.

ADJA ;T RIPARIAN PROPERTY OWNER STATEMENT
(FOR A ER/MOORING PILINGS/BflATLIFTBOATAOUSEJ
I hereby certify that I own property adjacent to J, 1\ '( <� A A 6 )S
(Mime of p perty owner)
property located at al }
��(��Lot, block, road, etc.)
on , in IN 11 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 afieDmooring
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 that setback requirement. q t.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filled in by individual proposing development)
Sep Oil�h� p�-e-
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
a�.
Print or Type Tiame
Telephone Number and Date

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DCM COMPLIANCE INSPECTION RECORD