48939_PALM SUITES OF AB_20070531

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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 '
C'.
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC /
❑ Rules attached.
Applicant Name /4 �i ' ; '� - = Project Location: County
C.
Address �' f �' l ? /�rr�' Street Address/ State Road/ Lot #(s)
City State ZIP
Previous permit #
Date previous permit issued
Phone # ( )
Fax # ( )
Subdivision
Authorized Agent
City
ZIP i-
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # ( )
River Basin ,.
Affected
ElOEA
AEC(s):
ElHHF ElIH ElUBA ❑ 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
rio
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: /t_/ f_,1 )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date 9xpiration Date
Application Fee(s) Check # 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 consistentwith 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

PIMAY 1 0 M7
CERTIR' IVAIL - RETURN; RECEIPT RE
99 ���.�,_ead City aCIVI
DIVISION CP COASTAL NIANAGEkliEi\4�T
ADJACENT RIPAPIAN PROPERTY OWNF-i NOTIFICATI®NfWAIVER PCRM
Name of Individual applying for Permit: Palm cAt4--S a r ohc- &c�)
Address of. Property: 60a kv. C°r ¢ ocdx- /Vlc: 5%-
(Lot or Street #, Street or Road, City & County)
hereby certify that I own property adjacent to the above referenced .property. The
individual applying for this permit has described to me as shown on the attached drawing
the development they are proposing. A description or drawing, with dimensions, should be
provided with this letter.
l have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Coastal Management, 400 Commerce Avenue, ,Morehead City, MI..', 28557 or call (252)
808-2808 within 10 clays of receipt of this notice. No response is considered the
sarne as no objection if you have been notified by Cortifxed Afail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift.or sandbags
must be set back a minimum distance of 15' from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
beloP&'kdo
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Pint Nam c.
Telephone Number With Area Code
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'• (FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
.s d
•ram
I hereby certify that I own property adjacent to
(Name of Property Owner or Applicant)
Mailing address if different from location address
(town, state and zip)
phone numbers you
property located at
(Lot, Block, Road, etc.)
on titer , in _ , 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. 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.
t is
I do wish to waive that setback requirement.
initials
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing develo ment
R9F to
NUTF
MAY 1 0 Z007
Morehead City DCM
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Print or Type Name
elephone t umber
Date: (- ° —
w,.vw. nccoastalmanaaement. netIPermits/ADIACENTRIPARIANPRO PERTYO WNERSTATE:I,fEivT. pdf

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MAY I 0 7001
CERTIFIED MAIL •RETURN RECEIPT REQUESTEDmutehead City DCM
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: Palm -he- &ac/
Address of. Property: ©a IN. r" m�'�- � � � &a V C`
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced .property. The
individual applying for this permit has described to me as shown on the attached drawing
the development they are proposing. A description or drawing, with dimensions, should be
provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Coastal Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call (252)
808-2808 within 10 days of receipt of this notice. No response is considered the
same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift.or sandbags
must be set back a minimum distance of 15' from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below)
V-3'*do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
/ — 2—c) sz,7
Pint Namr
Telephone Number With Area Code
Q�-7/<-S'cpq(-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Nance of Property
Mailing address if different from location
M
N
's
(town, state and zip) _ _ _ AY 1 0 2007
phone numbers you can be a - IVI
property located at
(Lot, Bock, Road, etc.)
on �� -,in
(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. 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.
t sls
I do wish to waive that setback requirement.
«i<<ais
DESCRIPTION A_ND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
---------------------------------------------------------------------------------- --- ------------------
Sig: azure
(Y, P' & rn�f►�
Print or Type Name
elephone number o
Date: - L:
www.nccoastalmanasement.netlPermitsiADJ ACENTRIPARIAN PROPERTYOWNERSTATF-NlENT. pdf

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MJ CONSTRUCTION, INC.
P O BOX 628
MOREHEAD CITY, NC 28557
Wachovia
W achovia Bank, N.A.
wachovia.com
66-21/530
5/9/2007
PAY TO THE CAMA I $ **200.00
ORDER OF
Two Hundred and
CAMA
MEMO Permit "Palm Suites of Atlantic Beach, NC"
ii•00 16 20ii' i:0 5 3000 2 19i: 20000 2 6
i
1620
DOLLARS n

0
DCM Permit Monitoring Program
County: y-ems �fi Applicant Name:, II )� J
j 1
Permit Number: `��%3�C- Contractor:
Project Location:
Expiration Date of Permit: 3
Authorized Development Activities:
Date Monitored: -Z �� Applicant/Contractor present? Y or
Work complete as permitted? N Field Rep. Present < Y'or N
If NO, then complete the below item that applies to development activity:
1. Work in progress and/or the following development has not been completed:
2nd site visit:
3rd site visit:
4th site visit:
2. The following modifications were made to active permit for unauthorized work:
3. The following unauthorized development occurred.
NOV date:
Comments:
NOV number: