47858_LANE, BILLY_20070215

8
❑ CAMA / ❑ DREDGE & FILL
�• `'
,. GENERAL PERMIT"
Previous per it
❑New ❑Modification ❑Complete Reissue
❑Partial Reissue Date previous r it 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
El Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
CityState ZIP
Phone # ( ) Fax # ()
Subdivision
Authorized Agent
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /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
Signature Please read compliance statement on back of permit
(Scale: )
I At
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
Expiration Date
Application Fee(s) Check #
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 [)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 consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
El 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/ 1-888-4RCOAST
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

Feb 15 07 12:19p BILLY LANE 919-644-1028 p.1
North Carolina, Department of Environment and Natural Resources
Division of Coastal Management
MAidiad F. Easley, Gcvemor Charles $,.lanes, Director wil lm G, Rnss Jr., Seemary
D$tc c-t,-=.,E) 7 _�..
Applicant Name
Mailing Address 'I x 1 ��'11�-IZc�►'� r1 a�G
U 7
T certify that I have amftarized (agent) � �1 � MADP to act on My
behalf, four the purpose of applying for and obtaining sill CAMA Pemits necessary to
install or construct (activity)
at (location) , 4 --
11�;s certification is valid thru (date)
SigAatvre , r � ��
1
400 commerce Avenue, MvrsheW City, No* C=rma 28557
Phone: [phone] %FAX: 252.247-$330110emet: www,rieeaastalmnagernerwLnet
Jar E*A Cppo+iurity%Aerm*"A00n Frdayw—W.N. Rxeydad) 10% FMt CM9Bi WPaper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFT/BOATHOUSE)
& '3'
LI3N�'
I hereby certify that I own property adjacent to ! J'-
,/ (Name of Property O
property located at � ©z �I �/? qJ'r &1'6 y i?4__
(Street Address, Lot, Block, Road, etc.)
Ad
on RE)O I-i i 6. &)/ o V �1t a in ;J-I9N%, e 9r",t/?��.
(Waterbody) (Town and/or County)#j%
He/she has described to me, as -shown below, the development he/she is proposing
location and I have no objections to this proposal I. understand that a pier/moorin )
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 have indicated my intentions by initialing below:
do not agree to waive the 15' setback requirement.
(initials)
e ry I do agree to waive the 15' setback requirement.
(initials)
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Ariz./ E e-1 c--- / /
Print or Type Name
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Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
4ke 17
I
(Name of Prope���
property located at ,L Cr'4t1S'Fog _••``��
(Street Address, Lot, Block, Road, etc.) %y
4; 1p�
on M'DonlLi j 8AY 0Y 064f � , in f3T/_Ay7;c &'Aeti lU.d C.
(Waterbody) (Town and/or County)
Q
He/she has described to me, as -shown below, the development he/she is proposing at
location and I have no objections to this proposal. I understand that a pier/mooring
pilings/boatlift/boathouso must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not'agree to waive the 15' setback requirement.
(initials)
I do agree to waive the 15' setback requirement.
(initials)
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
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Print or Irype Name
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Telephone Number
Date: / - / 5 - 2 o6n