60211_NG, ANTHONY_20120518

1,_1CAMA / I — DREDGE& FILL /'✓ NO. 60211
GENERAL PERMIT Previous permit#
LNew ❑Modification C.Complete Reissue F1Partial 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 i y' S :: Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP - �>
Phone # (_) / + Fax # ( ) Subdivision_
Authorized Agent City ZIP
Affected 1 CW EW QQPTA DES ❑ PTS Phone # ( ) River Basin
C OEA HHF ❑ IH ❑ UBA El N/A AK(s): Adj. Wtr. Body (nat /man /unkn)
C PWS: 7FC: �.
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
r
Basin, channel T�
cubic yards
Boat ramp
j
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
i
SAV: not sure yes �no
Sandbags: not sure yes ;no —
Moratorium: n/a yes 'no
Photos: yes qo
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
IN
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's -Signature
Issuing Date 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:
'�I 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)

x
ANTHONY NG
TERRY P NG 6447
NCDL 3301107 3871633 Ph 252-353-8905 66-21/530
3807 Sterling Trace Dr BRANCH 77639
Winterville, NC 28590
Pay to the Date
Order of
ollars
wAcxov>ca
WachhovIaa Bank, a dlNslon of Wells Fargo Bank, N.A. Q f
For L/ -epwA
':OS30002191:1066098SS2St,Sil' 6447

Description and Drawing of Proposed Work
Property Owner: j
Section Number: Lot Number: �7-
'i
Owners Name:
Address:
Telephone Nu
mber:
n q
E-mail Address. y�
Contractor:
Company Name: J
Contact Person:
A s- 1 C'
kyAL coll
- ro, ck- r(-j
AI- . ll }—� So �j _ U o !,
Telephone Number:
E-mail Address:
Detailed description of proposed work: IC
U
C�
doc k i Z` X" DLy
"To -scale" drawing of proposed woEJ
V. 11/1/08

Property Owner's Statement
Adjacent Riparian
Adjacent Riparian Property Owner:
Section Number:
Name:
Address: v G
Telephone Number:
Lot Number: , `'
G
E-mail Address: --- -
I hereby certify that I own the property adjacent to:
Section Number: i r
Owners Name:
0
Lot Number:
j2-
Address:
Telephone Number:
i/tdha It, k
E-mail Address: rk as shown on the of the
individual applying for this permit has described to methe- scope of no objections t the propo ed work. I understandched that
The ifrom my
"Description and Drawing of Proposed Work" form and
docks, flings, tie poles or any other marine structure must beset back a minimum of fifteen feet (15 -0 )
do , p
riparian line unless waived by -me.
vesI do not wish to waive the setback requirement.
D
N y q 20,
DC,yf�
Cam,
I do wish to waive the setback requirement.
Adjacent Riparian Proy Owner:
Signature
Print me
Date
Rev. 11/1/08

Permission to Use Adjacent or Other Property
Initiating property owner seeking permission to utilize adjacent or other property:
'L� ! Lot Number:
Section Number: Owners Name: ZOJ
Jahl�,S
f 2
Address: q o �CMC,
E-mail: _
Telephone Number:
Adjacent owner or other owner of lot to be utilized:
Section Number:
Lot Number:' 1 -7
Owners Name:
Address: �O
E-mail:
'k L rfi
3�-3--377?
Telephone Number: T
the lot
ified above
As the initiating property owner, I understand that I am responsible
to thegroany damage und ound and ground cover bytregrad regrading and used
any dam
by any activity of the contractor. I agree to repair T
seeding, and, if waterfront property, sodding any areas within 40 feet of the water. I have attached a copy of the
"Description and Drawing of Proposed Work" form for the adjacent or other property owner's information.
Initiating Property Owner:
Signature
Print Name
Date S
Adjacent or Other Property Owner:
to be used during the course of construction with the understanding
I agree to allow my property, as identified above,
that any damage will be repaired as stated above.
Signature
Pri/P-I
^
y
- s 2
Tla —
Rev. 11 /1 /08

Adjacent Riparian Property Owner's Notification
by Certified Mail - Return Receipt Requested
Adjacent Riparian Property Owner: �
Section Number:
7
( Lot Number: n
Name: �} j
Address:
Telephone Number:
E-mail Address:
I hereby certify that I own the property adjacent to: %
Section Number:
Lot Number: f
Owners Name:
) tCJ (t
Address:
Telephone Number: �}-
�� ��� �t � IW�C
E-mail Address: —``5 kJ n
dividual a plying for this permit has described to me the scope of work as shown on the attached copy of the
Them P
"Description and Drawing of Proposed Work form.
_ I have no objections to the proposed work.
objections to the work being proposed, please write the Division of Coastal Management, 400 Commerce
If you have
Ave., Morehead City, NC 28557, or call 252-808-2808 within ten (10) days of receipt of this notice. No response is
considered the same as "no objection" if you have been notified by certified mail.
I unde
rstand that docks, pilings,'tie poles or any other marine structure must be set back a minimum of fifteen feet
(15'-0") from my riparian line unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Property Owner:
Signature
Print Name
Date:
Rev_ 11/1/08

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the revers
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.-
1 k
c t;
rw4iy� )
by (Printed Name)
❑ Agent
C. Date of Delivery
D. Is deliverYl address differerf from item 1? ❑ Yes
If YES, enter delivery address below: 0 No
3. Service Type
Certified Mail ❑ Express Mail
Re9Ire ed Retum Receipt for Merchandise
❑ Insured Mail Cj C.O.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number _ _ _ _ 0 Yes
(Transfer from service label) 7 011 35011 0003 14 0 9 6851
PS Form 3811, February2004 - -
Domestic ReturnReceipt
102595-02-M-1540
�Q17 350❑ 0003 1409 685Z
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