51090_MATTHEWS, MIKE_20070918

OCAMA / ❑ DREDGE & FILL C�,VI/f
GENERAL PERMIT Previous permit #
ONew ❑Modification ❑Complete Reissue OPartia Reissue Date previous permit issued j
As aiithorized(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
D Rules attached.
Applicant Name
Address �•, `% -�
City State`jZIP
Phone # O Fax # (� )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision �.ie
CityZIP
-`4'Z/
Phone # O River Basin
Adj. Wtr. Body' "f=' {nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
1
Signature Please re�a`d compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature r
�L
/ � f
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, 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 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

4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date —
Applicant Name
Mailing Address
I certify that I have authorized (agent)U�/1� XP� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification is v thru a
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMCENT
r1Vf7-C/R0477,(. � THOU")
�VOR A PIEW)WOORING P-rL1Nr'S18(-,4 - -
�7�}� �52 -��32
y 11t. adjacent to '�I�
,I-e,by rej�df�/ spat I own pr()PeAY 1%,' 'M-
CM! . ,, : T) " Owner)
(Ld7 Block, Road,
i --FL61�Al k
'7TAY)
-n
Irl r
O.V (FTown qn 0 C
,t,,body)
proposing at that location,
a
the development he is prop
has described to me, as shown below, understand that a -oieriniGoring
rid, I have no objections to his PrOPosal ftril- MY a7IM,
slboadilboaihouse ,rnu. fismnce- of -fifK-Tn JreeL (15')
Pilin mast be sfA- back minimurn 0
accessof pat i unless otraived by me.
p_D_Qt yish to waive the setback rmuire-mer: t.
I & wish to waive- that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEI C)MMENT:
(To be flied in by !n&V&utd PYVP0Sk9 d--v--'0PMe'zt)
Print or Type Name
111 - 9 6q
Telephone Number
Date: �C;

ADJACENT RtRPARTAN PROPERTY OWNER STATIEM'
(FOR A PIERIMOORING PILINGSIBOATL TIBOA7710USL)
I hereby certify that own I Property rty adjacent to VJ Q �`fiIn �.c. 5' s
(Name of Property Owner)
property locked at V-'- L^-A
(Lot, Stock, Road, etc-)
a �.` '�0; N.C.
on � r--1' 2
(Waterbody) (Town and/or C nty)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to hiss Proposal'
distance o ern feet (15') from my arethat a a
p ouse must be set back
of riparian access unless waived by me_
I .doh wish to waive the setback requirement
i wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be ftUed in by individa d proposing development)
G --.9,4--� ->
Signature
print or Type Name
Telephone Number
Date: aZ

AGNCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor James H. Gregson, Director William G. Ross Jr., Secretary
Date / `" 7 r
Applicant Name
Mailing Address
I certify that I have authorized (agent) :I 0o 1�:] �(' /) ( to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or cot
at (location)
This certification is valid thru (date)
Signature 4� z� � e
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

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