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11 CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previo s permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue V Date r vious 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
f - (] Rules attached.
Applicant Named"4
Address
City
State, . , ZIP
Phone #7)
t -
Fax # O
Authorized Agent t:...
Affected [ICW
A
0 EW
El PTA El ES ElPTS
Affecte ElOEA
❑ HHF
❑ IH El USA ❑ 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
Other
Shoreline Length
SAY: not sure yes
no
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required by: ^L'
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit"
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City , ZIP
' s
Phone # ( ) -''` River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
i r•
i
t •
� Y`. i.;
' 1
0.:
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
1 I°
Local Planning Jurisdiction Rover File Name
Application Fee(s) Check #

i
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
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

3sis
ADJACENT RIPARUN PROPERTY ONN ER STATENMNT
�i7G`Lw
I hereby certify that I own property adjacent to — s
(\`nme of Properly Owner)
p-0ixrty )C>:,ated at
(Lot, Block, Road, etc.)
on G'13iy/}L� OF9 kzzl-mouqfin �If%�2A<�S /•SL —Jz L--,Leo, N.C.
(Waterbody) (To'An and/or Count) d [3
He t�2s desc^bed tome as shown below, the d;!velopmen,. he is proposing location,
MAR 2 3 2007
a'td, I no object;on_ to his proposal.
- ------------------------WrShead-City DCM
DESC )Z)PTION AN-D/OR Di:A%V11C OF PROPOSE. DEVELOP, IE\T
(!o bC�I?i:Cf'
V V
------------------- ------ -�---------------------- - ------
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Print or Ty c^_ harm
TLI 3S3- 3 a i --
Te(,,nhone Number

A 1
ADJACENT RIPARIAN PROPERTY OWNER STATEMtENT
I hereby certify that I own property adjacent to Aa—d 7-To a Doro� Q , m 's
(\ame of Property Uri'r%r)
property located at l5 J c h h i 4er give
(Lot, Block, Road, etc.)
on C NFL ' ©yl s-�C Q� in .�%�}d2�/1s .0 s d� `�✓ /eZ , N . C.
( aterbody) (To'•n and/or County)
TR-
He has described to me as shown below, the development he is proposi ,WE`'
and, I have no objections to his proposal. MAR 2 3 2007
------------------------------------------------------- -- -Mor - - ----- ------
---------------------------- ad City DCM
DESCRIPTiO\ AND/OR DRAWL• G OF PROPOSED DENTLORMENT
(To be filled in b}'/individucil proposing dei-elopmer.t)
2 V / /6
PZ-
Sianature
Print o, Type Nam:
r�)212 121'64 I/ y�
Tel phone Ntim er

` WCUNR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director
William G Ross Jr S
Date -p
Applicant Name /��-P_ Q i To
Mailing Address
• ecre/t�ary
1
e
MAR 2 3 2007
Morehead City ACM
/53y NNi r�2 c7�E' I�/RA,&izS IS'L4Ai,�, NC
-
�S s
I certify that I have authorized (agent) "�/Z- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification is valid thru (date) 90 /!A/s
Signature,,
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement,net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled l 10% Post Consumer Paper

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MAR 2 3 2007
Morehead City DCM

PER-OTTO HAGEN
- - - -_ --- -.
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D. N. HAGEN
LIC. 237950 3450787
1129 LITTLE CREEK
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"PAY TO THE
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DURHAM, NC 27713140 7122
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