48497_MASON, TOM_20070521

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❑CAMA DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial 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
Previous permit #
ate previous permit issued
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Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
State ZIP
Phone # O
Fax # (! )
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
❑ OEA
❑ HHF ElIH ElUSA ❑ N/A
AEC(s):
❑ PWS:
❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. es / no
Agent or Applicant Printed Name
Signature Please read compliance statement on back of perrpit
r
Application Fee(s) Check #
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Permit Officer's Signature
Issuing Date r ,ExpirationDate
i
f�jl^t;(;, 9
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, 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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This certification is va1•d thru (date)
c�gn_Nttan•c � -- -----�-_�
400 Commerce Avenue, Priorehead CiN, North. Carmlima 28557
Phone: [phone] FAX: [phone] k fntemet: www.nc`oastaimanagement.net
An Equal Opportunity l Att!rmative Actior. Employer— 50% Recycled 110% Pest Consurner Paper

,P 'Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
I Print your name and address on the reverse
so that we can return the card to you.
0 Attach this card to the back of the mailpiece,
or on the front if space permits.
I. Article Addressed to:
U—
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GR'Addressee
B. Received by (Printed Nam C Date of Del'
7ry
D. Is delivery address different from item 1? El Yes
If YES, enter delivery address i4to : 0 No
3- Service Type
0 Certified MaiN"�P` Uixp,ress, Vail'.
A kN Ns �, El
f Registered O-Return-14eceipt for Merchandise
11 Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) El Yes
2. Article Number
(Transfer from service label) 7001 1940 0001 0025 8152
:IS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
1111 Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
IIII Print your name and address on the reverse
so that we can return the card to you.
0 Attach this card to the back of the mailpiece,
or on the front if space permits.
I. Article Addressed to:
A.
0 Agent
11 Addressee
B. Receivedby (Printed Name) C. E ate Del!
D. Is delivery address different from item 1? El Yes
If YES, enter delivery address below: F-1 No
3. Service Type
11 Certified Mail 0 Express Mail
C1 Registered C1 Return Receipt for Merchandise
Cl Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) El Yes
2. Article Number
(Transfer from service label) 71101 1940 0001 0025 8169_
:IS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
31
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!PS Form 380% January 2061 SwReverse tor� Instructions
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BROAD CREEK CONSTRUCTION 5�67
PH.252-745-4252
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MERRITT, NC 28556-9572
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