59638_MOORE, EDGAR_20120316

y ICAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
[-]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
❑ Rules attached.
f
Applicant Name i Project Location: County
Address Street Address/ State Road/ Lot #(s)
City__. State ZIP
Phone # (_) Fax # O
Authorized gent
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
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit ** Issuing Date
Application Fee(s) Check # Local Plan ningJurisdiction
Expiration Date
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, 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

PAY
TO THE
ORDER OF_
B PRESCOTT MARINE CONSTRUCTION
PO BOX 874 252-249-0149
ORIENTAL, NC 28571
C� A� p<
t.
2891
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DATE r' 1 472
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(� D O L L A R S
First Citizens
Bank
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FOR
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I

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
-po t5c)x -6 1
b Nca+X MC 9 � 7I

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
{� cr
S d3 Gh e lSrn- V-
evi B01 n, HC
A. Si%nature
v i —Vry v
B. Received by ( Printed Name) c. D to of Delivery
cp-�- v—
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1350 0001 6538 3707
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Own
Address of Property:
Applicant phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address: 5� ;]XofI Ja1' oc CIA
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, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
yit i e se u must initial the appropriate blank below.)
►Tdo wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
V-C-)
Print or a Name
S7g
Mailing Address
City/State/Zip
Telephone Number
Date
( ipa 'a � Property er Info y,�
Signature
Print or Type Name
M511idg Address
- s &
City/State
Telephone Number
en/ h �
Date

UNITED
• Sender: Please print your name, address, and ZIP+4 in this box •
�sco�
qC c.M-71

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
A. Mre❑Agent
X� ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
1. Article Addressed to: If YES, enter delivery address below: ❑ No
/ iLLaw hovn
`n/ y C, �'6 C V� 3X00"'Vegistered
ce Type
qt-vj �I N IJ ert�ed Mail ❑Express Mail
❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
2. Article Number
(Transfer from service labeO
4. Restricted Delivery? (Extra Fee) ❑ Yes
Q.04 1,.350 l��].Q1 .�,��8' 3iB44
PS Form 3811, February 2004 Domestic Return Receipt mQOfv_'� 102595-02-M-1540

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Own,
Address of Property:
Applicant phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:57 ll'Caoia\K) I�x
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
Wey are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in waiting within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement:net/contect dcm.htm or by calling 1-888-4RCOAST. 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, boathouse, or lift 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.)
_2� _ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature t x
r V [��p�� 1
Print or pe Name
,J<-7 6tg
Mailing Address
CK, 7
Cify/SfatwZip
Telephone Number
Date
cl s
(7Riarian Property Owner Information)
%
Signature
O
' I iP /� c ( � cv�to�`v
r�r
nPli i or Type Name
/7
Mailing Address
b
Cttyiate/zip /5
nS�- �7'-O�``r
Telephone Number
Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3 - 16-
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 3. Yt& , ►" dyiyiC CWS4KXfiQn to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) GL CI1)CK ,
at (my property located at) 113 P i-Hj' an
This certification is valid thru (date) l a / 3 t / 1 a
Cc
Property Ovfner Signature
Date

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