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CAMA / F-1 DREDGE & FILL 3P7, n n
GENERAL PERMIT '"
Previous permit #
❑New ElModification ❑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.
Applicant Name
Address )
State
ZIPS,.
Phone # (•) r
'? -
Fax # O
Authorized Agent
tk
- r'
t ,
CW
,[I EW
OTA ❑ ES
❑ PTS
Affected
AEC(s): OEA
❑ HHF
❑ IH ElUBA
ElN/A
C PWS:
❑ FC:
ORW: yes / no
PNA
yes / no Crit. Hab. yes / no
Type of Project/ Activity
Project Location: County
Street Address/ State Road/ Lot
Subdivision -- I i j
CityL 5 , 1 _ ZIP
Phone # ( _) `'� River Basin`
Adj. Wtr. Body i _ (nat /man /unkn)
Closest Maj. Wtr. Body_?
(Scale:
Pier (
Platf
Fing
Groff
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
SAM
Sand
Mori-
Phot
Waiv
r pier(s)
lengthC
9��■SU■■■&INSIMM-doftm
■
■
I■■�■■■��■■■■■ice./■■■j�hi�i�li%■■
numberRiprap
■■�■■�wh/■■■
length
. distance•
max distance offshore
�i
SSEEN
EEN■■�
■�■Pincubic
�r�■■
�r
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■
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a
i
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N
yards
ramp
i
icl
■Kom
►�M■■"I
Nine Length
not sure (fes, no"t
�ags: not sure yes noorium: n/a yes no
yes 'no
rrrr..�
,:vw■■i■■■■�_■■
1
■i�iiiiiiiHl
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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 #
❑ See note on back regarding River Basin rules.
/4_ 1
Permit Officer's Signature
11 l
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:
I Tar- Pamlico River Basin Buffer Rules ❑ Other:
71 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

1425
CARL HEVERLY NCDL# 6078185
7306 CANAL DR., PH. 252-354-7154 g 66-30/531
EMERALD ISLE, NC 28594 Datey ~ �- 342
Pay to the /�j .2OQ o
Orderof '�1'_ L
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T Dollars 8 r.
FIRST CITIZENS 342
13,�AT71 Firs4Citizons Bank B Trust Company
(-►l 4 ►� Capo Carteret, N.C. 285B4
www.firstcitizens.com
For oc�c 45 - Brocl<—
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'JUL 18 2003
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ADJACENT RIPARL-�N PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
iUL 1 8 2003
I hereby certify that I own property adjacent to 's
(Name of P6perty Owner)
Property located at CC) 504C'L4' J D,-
(Lot, Block, Road, etc.)
on (�O!! r 5v , in Cut2vc �� �5�� , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that Iocation,
and, I have no objections to his proposal. I understand that a pier/mooring
piiinRs/boatlift/boathouse must be se: back a minimum distance of fifte--n feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I d-Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Zp'
ry
Signature
Print or Type Name
Telephone Number
Date: — `7-- 2 00,3

ADJACENT RIPARUN PROPERTY OWNER STATEMEINU
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
JIJUL 1 8 2003 I hereby certify that I own property adjacent to C j�,�s s
(Name of/Property Owner)
property located at
(Lot. Block, Road, etc.)
on Ba4u c 56, J _,in F""'erc,,(P , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be se: back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I dD wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP.% EN-T:
(To be filled in by individual proposing development)
t 40 �VA
E
Print or Type Name
Telephone Number
Date: i`'�