51005_BLACKWOOD, JOAN_20070827

T/I Ot1p) 47V9
11 CAMA / Ll DREDGE &.FILL
GENERAL PERMIT
ONew LIModification DComplete Reissue ElPartial 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_
7 16 "Lo'
Previous permit #
Date previous permit issued_
0 Rules attached.
Applicant Name Project Location: County_
Address Street Address/ State Road/ Lot #(s)
City i State ZIP
Phone # aM� Fax #
Authorized Agent
Affected [-1 Cw El EW E PTA F1 ES Ll PTS
AEC(s): LJ OEA D HHF El 1H EJ UBA [I N/A
El PWS: El FC:
ORW: yes/ no PNA yes / no Crit.Hab. yes / no
Subdivision
City ZIP
Phone# O River Basin
Adj. Wtr. Body_ I
A ( -- �-- (nat /man /unkn
Closest Ma. Wtr. Body /V ye i
MEN
ME
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
VO -i�!--'-
Agent or Applicant Printed Name -
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check 4
A:1
PermitOfficer 's Signature
Issuing Date Expiration Date
p J A
L/
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 [)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

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date T/b-3
Applicant Name =octn 1�01c kwnnd
Mailing Address
Vi• W6111111111 E KC--Td- •
I certify that I have authorized (agent) P,,k-'f;/+ t.?&LN8Cfsv,-jto act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) — S n�g ,� n 1.D.
This certification is valid thru (date) (a
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

' COMPLETE•
j ■ Complete items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery is desired.
ti ■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
v'-r j !7
L
2. Article Number 7006
(Transfer from service laoeq -
A. Signature 1
�n j ❑ Agent
X / UUI"�^ /� ❑Addressee i
Aelved by (P bted Name) C. Date of Deliv
C
D. Is delivery address different from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Servic
0' ertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
14. Restricted Delivery? (Extra Fee)
2760 0002 1899 9129
❑ Yes
1 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-NI-1e40
L

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
5c0 '2_ LA
!IIli11))iillIIIIIiIiiiiIIiIIliiII I! i i!)) I i) I i l!))) I i!) 1 I l 1111

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORIIVG PILL VGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to IRON/ r l ��,� ����� -j 's
(Name of Property Owner)
property located at
Block, Road, etc.)
on ��� s Ica ),-A< /�� e in _ 1�' , ��J— , N.C.
(�Vaterbody) (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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
6e�e- a 4e,- C,-O-C�
------------------- --------------------------------------
tt Signature
op-
-� Print or Type Name
Telephone Number
Date: ) 5�-- Sy 4 g 5"� 3

Page 1 of 1
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HEATHER ANDERSON
SCOTT ANDERSON
5002 GREENBRIAR LN. N PH. 252-237-9453
ILSON NC 27896
66-1231/531 2063
1032820
DATE M�glo7
W'
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� PAY TO THE 1 $ ,100. o
ORDER OF �
DOLLARS LJ u.y
fit ❑Cornersto e
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