58159_NEWTON, DOUG_20110720

El CAMA / ❑ 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
El Rules attached.
t `t 1
Applicant Name
Project Location: County
Address
I Street Address/ State Road/ Lot #(s)
City State ,ZIP
;
Phone # () Fax # ( )
Subdivision
Authorized Agent
City_ ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # () River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab.
yes / no 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 **
Application Fee(s)
Issuing Date
Check # Local Planning Jurisdiction
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
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
❑ Neuse River Basin Buffer Rules
❑ Other:
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

SAMMIE E. TURNER
MARINE CONSTRUCTION ACCT
252-725-3415
P.O. BOX 1885
MOREHEAD CITY, NC 28557
PAY
TO THE
ORDER OF
5212
66-112/531
DATE 7O's — l
$�
DOLLARS 8 SeLy Y Dete eon
6ecF.
BRANCH BANKING AND "TRUST COMPANY
t-800-BANK BBT BBT,c . qq
FOR
4
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11 21 :000S 210SB406611° -
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s
RECEIVER
JUN 21 2011
DCM-MHD CITY
Nott Carolina Depa rment of Environment and ^yatura! Resources
E)msi0q, i3, Coastal Management
Michael F. Easley: Governor Charles S. ,Jones, Director William G. Ross Jr., Secret s!
Date
40kant dame
.M.Aing Address g� �9 C{� j�jJ�P l 9 � t•{) LLS D+� `��
f�
C
` Q p I certify that i have autborize4d (ageent) to aed On axe
behalf, for the purpose eIi appiying for and obtaining all CANIA Permits necessary to
inst"O or Construct (aCtivity)---
at (location) 3 O -:). FOR R�S�
This certification is 'aIhrl fihru (date)
sil nature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to DOUG Nk h! % Oh4 Is
(Name of Property Owner)
property located at -30 a ORIR �:ST K'NOL.. Z>R ,
(Lot, Block, Road, etc.)
on E30C3UF 50U Nb in ATLANT1 e- fie , CA iR I -?FT N
(Waterbody) (Town and/or Coun ) ®�
Applicant's phone #>-c%��I)� 3110%22 Mailing Address:acl 3<�) Cm( Apxyq OILS '�'R
W 1 L.IALNG i >N HC A Ry 11
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
---------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled i ; property oppsing development) g�� T I L
(( ,.,ram_ ,
i
� - - - - - -
(Ihf mation for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature
Date
� y a ��ID
�p
• �ofob'sg a 1 ZD
�/ ------------- : ---------------------- L----
(Riparian Property Owner Information)
ignature
Print or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -POUG NEW T W4 is
(Name of Property Owner)
property located at 30 � �0 �—[" !KNOLL D1� Oc, '9
(Lot, Block, Road, etc.)
O!
on gO C-Ue SQLWD , inATj-,&,NTIC k�c-I-�. � �Tt' (,N.C. !
(Waterbody) (Town and/or Coun ty)
Applicant's phone (91-2�-bCCQ 'Mailing Add ress:C9930C41A PIb14 4IN3 bkt-
W)LN\igC � 4 rqc- -:;,>MiI
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To healled in by property ow` f proposing development)
1396E ZJ 65
T4 D
S
-- - - - - - ---------- ----- --
( rformation for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
---------------------------------- for-----------
(Riparian Property Owner Inmation)
Signature
Print or Type Name
Telephone Number
Date

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awl
A.Oplicant i
Date:
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 1YPE
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
ount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
ternimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other ❑--
v
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
L� J
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