49882_KELLY, TOM_20070823

❑6AMA`/ ❑ DREDGE & FILL cb7i0lo-c wf,,� 49F,82
-. GENERAL PERMIT c/ Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial eissue �% 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 I SA NCAC
EJ Rules attached.
Applicant Name ^� -'
r i
t
Address 1'0
1< E'•�er
`ara:., ,.ul
i{
Cityt. 7
State
ZIP
Phone # O . , i
i +
Fax # (^)
Authorized Agent
Affected El CW
❑ EW
❑ PTA ® ES
❑ PTS
AEC(s): El 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 _ I_
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
Moratorium: n/a yes no
Photos: yes _
Waiver Attached: yes no
A building permit may be required by: _
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
a `fir
Application Fee(s) Check #
Project Location: County L f
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP "5
Phone # O River Basin'
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: j,. )
V
J
I V �
❑ See note on back regarding River Basin rules.
PermitOfficer's Signature
tl)
Issuing Date
Expiration Date
Local PlanningJurisdiction
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, certifythat 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 complywith 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/ 1-888-4RCOAST
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

.�..
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor Charles S. Jones, Director William G. Ross Jr., Secretary
Date j S
Applicant Name
Mailing Address '5 / c
I certify that I have authorized (agent) 06) v " -? ILJ vim- - A to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Aju✓ is"r/� A e ti-J,
at (location)
5310
This certification is valid thru (date) S — 6 — (
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.ncroastaimanagement.net

4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to T-011 ^- It 'S
(Name of Property Owner or Applicant) p
Mailing address if different from location address S 3 (D i3c) -� �SC,ti�• ��l , ��
(town, state and zip)
E,,t, -ev- Vie( ,1 s
phone numbers you can be reached
A/: L, 2-kS—
s Ct
property located at S 3 / d (- S cxx e,
(Lot, Block, Road, etc.)
on �Gr �/� , in car ft r��N.C.
(Waterbody) G rti 4't . (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.
I do not wish to waive the setback requirement.
initials
_ I do wish to waive that setback requirement.
initi-V
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f lled in by individual proposing development)
/"
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R,e111kcp- L';. �C'4
----------------
Signature /
Print or Type Name
�6
Telephone Number

08/22/2007 21:34 2523938280 THE UPS STORE PAGE 02/02
ADJACENT RIPARIAN PROPER'> N OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHrOUSE)
1 hereby certify that I own property adjacent to
(Name of Property Owner or Applicant)
Mailing address if different from location address-57-0 9� `' CIO
i^ r . t
(town,, state and zip) Z i"- W`
-c , NC : 2- 9 S7 ji
phone numbers you can be reached at ^ Z L 5 Z .5
property located at
c---e
(LOt, B)oa, Road, etc.)
on — � :.� So�`z'i Dir , in t, Ar'47 N.C.
(W>itetbody) (,q It (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.
1 do not wish to waive the setback requirement,
initials
I do wish to waive that setback requirement.
initials
.DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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P— e. V\n 0e-,
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Signature -
Print or Type Namc
- 1�i �— �039 ft
Telephone Number
3 -'1�R\,D - sq 341 (0)

ROGUE BANKS MARINE CONSTRUCTION, INC.
PH. 252-247-4428
111-D TURNER'S DAIRY RD
MOREHEAD CITY, NC 28557
PAY TO THE
ORDER OF_
IA.z,
l�
Wachovla
Wachovia Bank, N.A.
wachovia.com
66-211530
5425
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MEMO ~j 614aAj
AUTHOR ED SIGNATURE
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