47812_JACKSLAND, DICK_20070130

❑ CAMA / ❑ DREDGE & FILL //� 4 TR 12 y`
GENERAL PERMIT Previous permit# I i
❑New ❑Modification ❑Complete Reissue ❑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
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) Fax # O Subdivision
Authorized Agent CityZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (_n'at /man /unkn)
❑ PWs: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
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
SAV: 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:
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale:
This Facility is located within a Prin►ary Nursery
Area, and is not for boating use. No slips are
permitted for vessels -motorized, sail, or other.
Any kicking or prop wash will be considered a
t and of the CAMA and
's Permit, violation of this p ,
---—.
D &F Act.
] See note on back regarding River Basin rules.
Permit Officer's Signature
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date Expiration Date
Local Planningf urisdiction 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:
❑ 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

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OCT 2 5 zoos
DEVELOPMENT
PERMIT
In 1974, the North Carolina General Assembly, passed the Coastal Area
Management Act and set the stage for guiding development in fragile and
productive areas that border the state's sounds and oceanfront. Along with
requiring special care by those who build and develop, the General As-
sembly directed the Coastal Resources Commission (CRC) to implement
clear regulations that minimize the burden on the applicant.
This application for a minor development permit under CAMA is part of
the Commission's effort to meet the spirit and intent of the General As-
sembly. It has been designed to be straightforward and require no more
time or effort necessary from the applicant. Please go over this folder with
the Local Permit Officer (LPO) for the locality in which you plan to build to
be certain that you understand what information he or she needs.
Under CAMA regulations, the minor permit is to be issued within 25 days
once a complete application is in hand. Often less time is needed if the
project is simple. The process generally takes about 18 days. You can
speed the approval process by making certain that your application is com-
plete and signed, that your drawing meets the specifications given inside
and that your application fee is attached.
Other permits are sometimes required for development in the coastal area.
While these are not CAMA-related, we urge ,you to check with the Local
Permit Officer to determine which of these you may need. A listing is in-
cluded on page 2 of this folder.
We appreciate your cooperation with the North Carolina Coastal Manage-
ment Program and your willingness to build in away that protects the
resources of our beautiful and productive coast.
Coastal Resources Commission
Division of Coastal Management
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Locality Permit Number
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shorelin
(For official use only) PFI "C U'11
GENERAL INFORMATION OCT 2 5 2006
LAND OWNER t Morehead City DCM
Namer e%ko D -7 CD" S AOl�D�y p
Address
City /¢� C! �� State Zip Phone � SO?� '7 — 7 r /
ry�D/ZNIv��C: r e��
AUTHORIZED AGENT
Name
Address
City,
State Zip
Phone
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) 1' 1 o5g aF' v -Dii r I V , a I ADP�i G2+�Px GiP✓ek-toe tex)m
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
SIZE OF LOTIPARCEL:
square feet Z ' acres
PROPOSED USE: Residential (Single-family Multi -family ) CommerciaVIndustrial
Other
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVIRON-
MENTAL CONCERN (AEC):
square feet (includes all floors and roof covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON SURFACES IN THE
COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): square feet
(Calculations includes the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios,
etc., that are within the applicable AEC. Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property:
(I)within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2)within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding Resource Waters
(3)within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES NO V
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

OTHER PERMITS MAYBE REQUIRED: The activity you are planning may require permits other than the CAMAPi
permit. As a service we have compiled a listing of the kinds of permits that might be required. We suggest you che
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your LPO to determine if any of these apply to your project. Zoning, Drinking Water Well, Septic Tank (or other saaste treat- 1'
ment system), Building, Electrical, Plumbing, Heating andAir Conditioning. Insulation and Energy Conservation, FIA Certif Sand
Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and others. '2 5 20
More 06
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or XY 0C114
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the "
person listed as landowner on this application has a significant interest in the real property described therein. This interest
can be described as: (check one)
man owner or record title, Title is vested in , see Deed Book _._
page _ in the A'" `I Lb County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
ame) ,,
(Address)
O S�al-gC
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may be susceptible
to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the particular hazard problems
associated with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing
techniques.
PERMISSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents
to enter on the aforementioned lands in connection with evaluating information related to this permit application.
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any
information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.
This the %8-1q1 day of CC 4-o4e"L5-- , 20 0'4
Landowner or person authorized to act as his agent for
of filing a CAMA permit application.

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor %F41
opment&rmit.The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you, ifted.D 2
PHYSICAL DIMENSIONS �e1pry
Label roads
Label highways right-of-ways
Label local setback lines
Label any and all structures and driveways currently existing on property
PHYSICAL CHARACTERISTICS
Draw and label mean high water mark
Draw location of on -site wastewater system
If you will be working in the ocean hazard area:
Draw and label dune ridges (note height)
Draw and label toe of dune
Identify and locate first line of stable vegetation
Draw and label setback line under CAMA
Draw and label topographical features (optional)
If you will be working in an estuarine shoreline area:
Draw and label landward limit of AEC
Describe terrain (slope)
DEVELOPMENT PLANS
Draw and label areas that will be disturbed
If a house is to be placed on lot, describe location of house
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled
Describe composition of surface
Note and list fully all trees and vegetation to be removed or relocated
Show landscaping
NOTE TO APPLICANT
Have you:
• completed all blanks and/or indicated if not applicable?
• notified and listed adjacent property owners?
• included your site drawing?
• signed both application and statement of ownership?
• enclosed the $100.00 fee?
• completed an AEC Hazard Notice, if necessary?
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site Inspections
Date of Action: Issued Exempted Denied Appeal Deadline (20 days)

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