58885_NCWRC - WILLIS LANDING SITE_20111012

1CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
ENew ❑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
❑ Rules attached.
Applicant Name
Address
t
City__ j ti r f •1l State r ZIP
Phone # ('�) "�U"?Ca�,� Fax # ( )
Authorized Agent
Affected ❑ CW EW PTA E ES ❑ PTS
AEC(s): ElOEA HHF ❑ IH ElUBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) �! C _�- PC' �'i River Basin j' to
Adj. Wtr. Body t (Sat /man /unkn)
Closest Maj. Wtr. Body ti !
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
d L hi
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, 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 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.
Raleigh, NC 27604
919-733-2293
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

Oct 7, 2011 7:44:15 AM
OCP AP DOCUMENT PAYMENT GENERAL INFORMATION
NEXT FUNCTION: ACTION: HISTORY:
BROWSE:
PAY ENTITY 17PT VEND/EMP NBR:
VEND/EMP SHORT NAME: DENR DOCUMENT NBR:
DOCUMENT DATE : 10/06/2011 PAYMENT NBR:
IND AMOUNT
SALES TAX/VAT
SALES TAX 2
SALES TAX 3
FREIGHT
ADDITIONAL COST
GROSS INVOICE
PAYMENT AMOUNT
AMOUNT PAID
400.00
400.00
400.00
PAYMENT TERMS NET PAY IMMEDIATELY
PAYMENT DATE 10/06/2011
PAYMENT ROUTE CD
FACTOR NUMBER
REASON CODE/DESC
DPG
10/07/2011 07:43:46
-------------------------
566000372 40
WILLISBAA100611.
001 PRTL PYMT NBR: 000
VAT INCLUSIVE N
EXPENSE IND
GL EFFECTIVE DATE: 10/06/2011
EXTRACT DATE
ACCRUAL CANC DATE:
CURRENCY CODE
DISCOUNT
TYPE
NOT TAKEN
DISCOUNT
TAKEN
PAYMENT
STATUS
PAID
PAYMENT
REF NBR
0000052823
PAYMENT
TYPE
ELECTRONIC
HANDLING CODE
ONE INVC PER PYMT: YES
BANK ACCT PYMT CD: IGO
11

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■ 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:
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A.,Signa f
X �., f C ❑ Agent
j� ��� L�-t� j ❑ Addressee
B. Received by (Printed Name) C. D to of Delivery
D. Is delivery address different from item 1? ' ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
P Certified Mail ❑ Express Mail
❑ Registered p Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2- Article Number
(Transfer from service label) 7006 0100 0000 5372 3279
PS Form 3811, February 2004 Domestic Return Receipt
■ Complete s`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:
102595-02-M-1540
KMZ, Ac
w c�lved by (Printed Name) C. Dpte of
B. �e
D. Is delivery address different from item 1? u Ye:
If YE .enter delivery address below: ❑ No
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3. Service Type
MCertified Mail jO Express Mall
{] Re [R Return Receipt for Merchandise
� nIst
❑ G� ail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7006 0100 0000 5372 3286
(transfer from service label) —_ — _ _ -----
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540