49765_KARL, FRED_20070720

❑CAMA / ❑ DREDGE & FILL t /),� 71";',5
-. GENERAL PERMIT Previous permit # ,
❑New ❑Modification ❑Complete Reissue ❑Partial Reissu 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 # O
Fax # (�)
Authorized Agent
Affected 0 CW
EJ EW El PTA ❑ ES ❑ PTS
AEC(s): OEA
D HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
-- 11
within a Primary Nursery
use. No slips are
sail, or other.
wash will be considered a
and of the CAMA and
.. .. _ ,
I
{--- —
�I See note on back regarding River Basin rules.
Pier (dock) length
Platform(s)ling
Fingerotorized,
Groff
Bulk
Basin
Boat
Boat
Beach
Other
Shoreline
SAV:
Sand
Moratorium:
Photos: yes no ;
Waiver Attached: yes yno
A building permit may be required by:
Notes/ Special Conditions
This Facility is located
Area, and is not for boa
O
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) - Check #
Permit Officer's Signature
7
Issuing Date �� Expiration Date
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 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:
❑ r - Pamlico River Basin Buffer Rules ❑ Other:
L�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/ I-888-4RCOAST
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

07/18/2007 08:07 1 PAGE 01
AWE CENT RIPAR &N PROPERTY OWNER STATEMENT
WOR A PIERIMOO ING PILINGSBOA,TLIFTIBOATfIOUSE)
I hereby �eirtify that I own property adjacent to 1 eV oyd '-le'e is
(Name of Property Owner)
property located at 31 'S'166R5
(Lot, Block, Road, etc.)
onS�-C RS 'Ear J An _ N.C.
aterbody) (Town and/or County)
He has descried to me, as shown below, the development he is proposing at that location, and, I
have no objeaions to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set b4c� a minimum distance of fifteen feet (151 from my area of riparian access unless
waived by rn� �(if you wash to waive the setback, you must initial the appropriate blank
below.)
I dg pQt wish to waive
swish to waive that setback requirement.
------------------ ------------------------------------------------------- -----------------------------------------
VES00WION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
1
I U rJ i-r FI r-'">
/-gJfffA r V�.yJ✓ IAA����'� 1�
Print or Type Name
Telephone Number
Date: Op

Adjacent Riparian Property Owner Statement
(FOR A PIER/MOORING PILINGS/SOATLIFTBOATHOUSE)
I hereby certify that I own properly adjacent to lCo'e-j �-eeDw i;C-Y is
Name of Property Owner
property located at 31 3p:�,S Cer-c � y P e-TUE
Lot, block, road, etc.
on V-_ , in GP e-n-VA 1 , NC
Waterbody 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 do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be filled in by the individual proposing development)
im-ILw
- usbtVps i I J
Signature
-t
Print or type name
Telephone number
Date
I L,) VIV V;:�7E( 0.
http://www.innerbanks.biz/arpos.htm 1/29/2006

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FIRST K CITIZENS
First -Citizens Bank & Trust Company
Raleigh, North Carolina
Pay to the
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CAL �D— ��-iiYER $1,OD0 00 - IN LW. AFTER 180 AY
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July 20, 2007 05271869
$400.00
05.1007OR (8/04) - Remitter NNTi26ANKS
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