46783_MATAST, JACQUE_20061023

❑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 I SA NCAC.
Previous permit #
Date previous permit issued
❑ Rules attache
Applicant Name>>� r - ! Project Location: County
Address x Street Address/ State Road/ Lot #(s)
City a' _ State ZIP ✓ 0 / _; % j %' r �'.
Phone # ((' % X "" 'Fax # (_) Subdivision
1
Authorized Agent ,�'j� beal City zip
ElCW ElEW ❑ PTA ❑ES ❑ PTS Phone # O River Basin
Affected ❑ OEA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC(s): 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
SAM 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)
Signature Please read compliance statement on
(Scale:
�� • _ See note on back regarding River Basin rules.
Application Fee(s) Check #
A Z066
Permit Officer's Signature
.CityIssuing 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
Iandowner(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
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to�is
�perty located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
&a!5 g(Jdpf P Noe
(Waterbody) (Town and/or County) �t�f%
He has described to me as shown below, the development he is proposing at that loos
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by indiv4dual proposing development)
1 8 2006 i
C%ty OC
M
6k1 rlpU64,5� �vEL- )cick 91� WOO" / CAP
signatuie
0-7.o-7-7,�?JV
Print or Type Name
,-,�5 .2 — 3S�
Telephone Number.
Date: O V �j

a
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ;/p,Q(y 'A( -s 's
(Name of Property Owner)
(Lot, Block, Road, etc.)
on A69 5 JAAD , in 6I#�eAI.Z %6 , N.C.
(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. ,1 . 15,
"
-------------------------------------------------------------------------------------------
1 p
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT "� ' i �i�!)6
(To be filled in by indiv,dual proposing development) "Oreh
FJ$C-R6
go Lx0 S .
ss P&vEL h'aLY1 4D 2 Wob" CAP
' Z&i�
Signature
R1W E , Ida k
Print or Type Name
Telephone Number
Date: /

Oct 30 OG 10:04a JACQUES MISTROT 919-782-73G5 P.1
N
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
Date /o ` i —6V_
Applicant Name
Mailing Addressg�('!� D7/1/�•
OL
I certify that I have authorized (agent)'2:a;T'-T1 �h�A� to act on my
behalf, for the purpose of applying for ands obtaining all CAMA Permits necessary to
�a
install or construct (activity) &14k /-� __ -
at (location)
This
Signs
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: wwwmccoastalmanagement_net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

BOONDOCKS-8s/r 1666
P.O. BOX 28
129 WETHERINGTON LANDING RD. DAi(
STEECLLA, NC 28582
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