51084_GALLAHER, ROB_20070914

❑ CAMA / ❑ DREDGE & FILL s 510 'R 4
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 of environmental concern pursuant to 15A NCAC ' ;�n>� % X'
El Rules attached.
Applicant Name ' > ; ,' )�' 11
Address
^�
City
tate
Phone # (_)
Fax # (�)
Authorized Agent
Affected ❑ CW
❑ EW Q PTA ❑ ES
❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA
❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length. 1-70
in
number
h Bulldozing
.-
1
T
not sure yes no
bags: not sure yes no
no
-tos: yes
E
mom
M
man
IN
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ME
M
M
OMEN
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length
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Agent.or Applicant Printed Name
Signature �� Please read compliance statement on back of permit
PermitOffrcer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
Application Fee(s) Check #

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/ 1-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

09/04/2007 23:27 12525278353 KIN5TON PULMONARY PAGE 01/01
09/1`0/290'� 19:27 25272G4e92 INTRACOASTALMARINECD PAGE as/az
Norbl Carolina Department of �'�ti�rofim�r�t and Natural Reaouroes
DivWon -of Coasfol m9 ag meat
Michael F. Eealey, governor Charles , ,loo.es, DOL40r Vdiam G. Ross Jr., Secretary
Date
SEP 1 2_2007
Applicant Naroae'
�G.�Ic� Lam'
ai�ad,� '� ,.0 �,',�'c�rehead City DCM
I certify that X have Authorized (agent) "r/'c to act on my
behalf four the pwTuse of applying for and obtaining all CAMA, Permits neemm y to
install or constmet (actiivi#) �
at 06cation) Z_co 0
This csvEwoatkon is valid
Signature
(date)
400 CrammeP Avenue, MDmhead Clty, NoM Carolina 26557
Phone: 252^808^2808'1 PAX, 252-247-3380 t intemet; www.n=astalmaw Wment.riet
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IntraCoasta 1 Marine
P.O. Box 298
Atlantic Beach, NC 28512
[phone]
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2 2007
City DCM

file
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOIISE)
I hereby certify that I own property adjacent to Ccl /1,51 `A (f'" 's
(Name of Property Owner or Applicant)
Mailing address if different from location address Su i-y\
(town, state and zip)
phone numbers you can be reached at-2-
property located at � 0, c sh O rc L i7y
5- o' q 7
D,,�U,.����� L s�
(Lot, $loclRoad, etc.)
on 'J C3 ✓`� �' u!u �� in �c��� CGy�
(W t ody) (Town and/or County)
He has described to me, as shown below, the develo ment he is proposing at that location,
and, Ihave no objections to his proposal. I understand that pie mooring piling ��oathoqse
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..., l;
initials
I do wish to waive that setback requirement. SF„ 2
initials 2007
-------------------------------- - ------------------------------------------------�------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMi
(To be. filled in by individual proposing development)
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Print or Type Name
Telephone Number
Date:
,ty 1)CM

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIB OA TLIFTIBOATHOUSE)
I herebycertify that I own property adjacent to ©�?/ �C, ! 's
Y r r Y J
(Name of Property Owner or Applicant)
Mailing address if different from ocation address SG k" Q
(town, state and zip) 6
G/� ,
phone numbers you can be reached at �� _ �� d _I pa V ,
property located at G L 0 �- Z j ,ty � O r' , ��L - � � /-
(Lot, Block, ad, etc.) -2 �-
�
on l3 O U C U N , in dN-, N.C.
(Wat ody) trown and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, Ihave no objections to his proposal. I understand that to mooring piling oa i oathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian aqQgss unless
waived by me.
I do not wish to waive the setback requirement. ';,,; +rg►
initials 4
I do wish to waive that setback requirement.
initials r /
_ M�rLh
------------------------------------------- ---------------------------------------------------=-------act
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: .y "0
i (To be f lled in by individual proposing development) l `''I
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it or Type Name
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Telephone Number
Date: � I t 077

INTRACOASTAL MARINE CONSTRUCTION
1512 SCOTT'S LANDING
MOREHEAD CITY, NC 28557
Date
Of
fW
BRANCH BANKING AND TRUST COMPANY
1-800-E" NK SOT
+�• BBT.co.
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For "
II'0000 16 3 2110 1:0 5 3 10 1 1 2 11:000 5 198 3499►, 30■ - --- - - - ----
1632
66-112/531
BRANCH 02301