48125_GUAY, ANTHONY_20070308

❑CAMA / ❑ DR,,-jPGE & FILL 4812,5
GENERAL PERMIT Previous permit # '
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -
As authorized by the State of North Carolina, Department of Environment and Natural Resources n
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /
Applicant Name
Address
City
Phone # ()
Au th ' id t
State ZIP
Fax # ( )
orze Agen �
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
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
L,Q Project Location: County i c-�
Street Address/ State Road/ Lot #(3)
i
Subdivision
City + ZIP
Phone # O River Basin
Adj. Wtr. Body. (nat /man,/unkn)
Closest Maj. Wtr. Body
(Scale: )
I i
I
4
Other
4
Shoreline Length
SAV: not sure yes r no) : __..-- -- -- - - --- --
Sandbags: not sure yes r` no'i
Moratorium: n/a yes ai
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
A
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
1�
is Signature
Issuing Date
Expiration Date
YOLA MA
Local PlanningJurisdiction
Rover File Name

• f
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 consistentwith 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

Appendix A
Certified Mail — Return Receipt Requested
Division of Coastal Management
Adjacent Riparian Property Owr;er Notification/Waiver )Form
Name of individual applying for permit: 4 l �e N, y /I y.
Address of Proert � / / � (` J) . .r i �� ,� / , _� _—_ -----
P y:__ _
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
Letter.
i
i
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Manage-
ment, 400 Commerce Ave, Morehead City, NC 2f657, or call [phone] within 10 days
of receipt of this notice. No response is considered the same as no obiectior if you have been
notified by certified mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, lift or sandbags must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (Ix you
wish to waive the setback, you must initial the app:-opriate blank below..
I do wish to waive the 15' setback regL.irement.
[ do riot wish to waive the 15' setback ,-equirement.,���
Signature �Y Date
Print name
Telephone Number with Area Code
A-3
Address or. Lot # in Fairfield Harbour

Appem ix A
Adjacent Rbparian Props rtty Owners Statement
(for a bulk -head, doc rinmooring pilings)
i 4 ereby certify that I own property adjac;ert to
(NWne of property owner;
propert , ] ocat.ed at �: �/� - _� '4.:_S
(Lot, Block, Road, etc.)
t Waterbody) (Town and./or County)
lie has described come, as shown tvlaw, the development he is proposing at that
,ocatYon. and, I have no objections to Luis proposal. 1 understand that a dock/inooring,
pl xings must be set back- a mini*nurr. distanc : of fifteen feet (15') from my area of ripar d.n
access Wriless waived by rate.
1 dg not %ish to waie,e the sett:ac.k requirement.
i dwish to waive that setback requirement.
Description and drawing of proposed developtnent:
7u be filled in by mdivtA al proposing �veiopnatnt)
D to
Telephone number

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GUAY 623.374.6922 P.1
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North Caro ina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
Date
Applicant NameJ7fo�/ ��✓.4
Mailing Address OBI J f'=
I certify that I have authlorized (agent) '' /a C �� 5 X! Cto c n my
behalf, for the purpose f applying for and obtaining all CAMA Permits necessary to
install or construct (acti ity) /1/ %/� % 1 �% / 1
at (location) Li' / ` �/} S ��`G' 1 /����'/,�r'�►�y,
This certification is
Signature
thru (date)
40C Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Oppo qunity 1 Affirmative Action Employer —50% Recycled 110% Past Consumer Paper