57132_MOORE, MITCHELL_20110228

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❑ CAMA / ❑DREDGE &FILL
GENERAL PERMIT Previous permit #
El New ❑Modification [-]Complete Reissue El 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 I i`s. I oo _ I Z 00
© Rules attached.
Applicant Name ,'n,-it Le ly 0C.
Address;
City State "� ZIP
Phone # O._ ii? Fax # ( )
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: qes /no
O EW ❑ PTA LJ ES ❑ PTS
❑ HHF ❑ IH Cl UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City r`6 c } ZIP
Phone # ( ) Z11l - G 3(. River BasinI(
` t
Adj. Wtr. Body 'IyyG ' r+vtf ^ cr tm ' Cr L"'S (nat / � /unkn)
Closest Maj. Wtr. Body C'
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Agent or Applicant Printed Name )
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officers Signature
Issuing Dat4 Expiration Date
Local Planning Jurisdiction 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, 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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Mitchell Moore
Date: 2/28/11
Permit #: 57132C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Open Water
Dredge 13 Fill O Both ❑ Other 0
128
128
Shallow Bottom
Dredge ❑ Fill 0 Both ❑ Other ❑
75
75
Shoreline
Dredge ❑ Fill ❑ Both ❑ Other ❑X
75
75
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10

NCDENR
North Ca olina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Goverrjor James H. Gregson, Director Dee Freeman, Secretary
Date . — I d /
Applicant Name '/
Mailing Address U' 5- 5 &G v, e t V
I certifythat 1 have authorized (agent) ��a4w4--I'to act on my
{g )
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 9�a.,-.
at (location) 3
p-#—g, q.- &,73 — %o D
This certification is vi ilid thru (date)
Signature
40� Commerce Avenue, Morehead City, North Carolina 28557
_ Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

CERTIFIED MAIL • RETURN RECEIPT REQUESTS
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. A)J 16 �G9 l ` Moor
Address of Property_ 5-130 -50M,10 A-, /iv0,,lg ✓/�
(Lot or Street #, Street or Rod City & County)
Applicant phone #: / C/ �a � � � /(Y%� %i Mailing Address- (:��5 -S&,-1,4
I hereby certify that I own property adjacent to the above referenced property. The individua!
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.
a_ 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 r[utit;e.
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WAIVER SECTI IV?
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
r:-sinirTlurn distance of 15' Ea rn my area of riparian access unless waived by me. (if you wish to
-,v61 �; 111 iu actiJcii r:, you inust initial the appropriate blank below.)
it"� I do wish to waive the 15' setback requirement.
; do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
N.1�-6 /Z
Punt or Type Name
Mailing Address l
City/State/Zi
Telephone Number
2. - /' - 26//
(Riparian Property Owner Information)
Signature
Print or Type Name
60w-
Mailing Address cJ
City/state2ip
35L4 - q3 3 7
Telephone Number
Date Dote
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02/15/2011 22:04 6106500842 TRINITY PRODUCTS PAGE 01
.
. - -
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PRC)PERTY OWNER NOTWCATK"AWR FORM
Name of Property Owner
Address of Property: 3
(Lot or #, Street or Road, CaY)
Applicant phone #: C _ �^Z Mailing Address-
ad' t to the above referenced Property The individual
t hereby certify that 1 own property lit t
applying for this permit has described to me as shown on ate anKbed drawirWhe M
they are proposing. AfAo� a
I have no o*ections to this proposal- I have objec6oas to this proposal,
if you hmm objections to what is being prgPa9000. You mVW n0tWY tier t)i hd6n of Co"W■ant
(OCM) in writing within 10 days of Mcd m of this nOO"- GwAaa &Wornm~ for OM ookT No
avaNabia at www.nccaitstatmar>ge+nenLttWiconteCt d 'is
htru or by
GAM9 I -
if ou hrtwe boas nodrIed by �10I —
rmmnse is consldared the saute as no V
WAIVER SECTION
t understand that a pier, dock, mooring pdmgs, breakwater, boadMS8, or fttt ffmst be set back a
minimum distance of 15' from my area of riparian access unless wai'wd by me- Of You wish to
waive the setback, You tin the appropriate blank below.)
1 do wish to waive the 15' setback nmquireff*M
i do not wish to waive the 15, sedk%* requiremw*
(Property, Owner Information)
Signature
Print or Type Name
Mailing re
Addss
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TeMphone Number
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(Riparian
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Terephane Number
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LARRY G ARNOLD SR
DBA LG ARNOLD DOCKS & SEAWALLS
PH.252-241-2636
2779 MILL CREEK RD
NEWPORT, NC 28570-6011/0 the
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1pffi-
2094
66-112/531
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Be�Fu�s
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B W A BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.com
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1:0531011211:0005295798 15911•0 094
HailaM Clarke
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