47856_PINER, GLADYS_20070215

❑ CAMA / ❑ DRED03E &' 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
Applicant Name
Address
City
State ZIP
Phone #
Fax.# (:)
Authorized Agent
Affected ❑ CW ❑ EW
❑ PTA ❑ ES ❑ PTS
AEC(s): 0 OEA ❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no PNA
yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
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
K
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
10
Application Fee(s) Check#
-v --7 i-S,,5
47856 -
Previous permit #
Date previous perr� it i$ ed
[P Rus attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # () River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
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

I
i
North Carolina Department of En-viroriment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. ,tones, Director William G. Ross Jr., Secretary
Date 3 — S - --?
Applicant Ninne
Mailing Address 6%
I certify that I have authorized (agent) ` lo�n� C(�L . to act on my
behalf, for the purpose of applying for and obtaining All CAMA Pcr�nits necessary to
install or cor
at (location)
This certification is valid thru (date) ( 2 - 3 -
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Intemet' www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Aeon Employer — 50% Recydad 110% Post,Consumer Paper

6 (ems 1(. P-%I e,
I have no objection of riff raff going in front of bulkhead.
Signature
Date
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CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAION / WAIVER FORM
Name of Individual Applying for Permit: I'
Address of Property: 1 '4 4-1'
(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--- I have no objections to this proposal.
If you have objections to what is being proposed, please write the division of Coastal
Management, Hestron Plaza H, 151 B, Hwy. 24, Morehead City, NC 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the some as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature
Print Name
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Telephone Number with Area Code Pity
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