43605_GOZART, ED_20051130

pia -5-65
i-1CAMA / -1 DREDGE & FILL �%4
GENERAL PERMIT
Previous permit #
LINew+ L IModification � ]Complete Reissue ❑Partial Reissue Date previous permit issue
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 `3r`' Project Location: County_ _
Address o ' ` ' f —_ i Street Address/ State Road/ Lot #(s)
City / r r, State ZIP ----- -
Phone # ( ) ���s Fax # () Subdivision i
Authorized Agent ?� °- City______- _ _ ZIP—___
Affected CW SEW pa"A EJES PTS Phone # ()_ _ - _ River Basin
-J OEA HHF ❑ IH ❑ UBA LJ N/A
AEC(s): Adj. Wtr. Body nat /-an /unkn)
PWS: ❑FC: f v /'/^
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity L--
Pier (dock) length—
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length _
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _—
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
� - (3 00 (c F- -e.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
j
(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:
❑ 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
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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

Nov 04 05 00:20a BELCHER 2527571072 p.2
Adjacent Riparian Property Owner Statement
(FUR A piERIMOORING KLINGSfBOATLIFTBOATHOUSE)
l herebycertify that I own property adjacent to [ t
r Name oi-15rgperty (Omer ! li ,
property Ideated at —----T�1%�2,r
Lot, block, road, e2r.
on r 4l in nrand'ocou� NC
�- Wnterbndy
fie has described to me, as shwwn below, the development he is proposing at that location and I have
no objections to his proposal.
I do nat wish to waive the setback requirement.
I do wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be fxlled in by the individual proposing development)
i
print or type name
Telephone number
� Dam

Adjacent Riparian Property Owner Statement
(FOR A PIF.RIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Cd copse'-' �- 's
r 1 ll- Name of Property Owner
property located at Lok - `7 Ot IC�S� y S in , I'Cr /i919
Lot, block, road, etc.
on 171,' C�-efS�-n l�Jd Wa , in 06(1-kp-�- , NC
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 do_ not wish to waive the setback requirement.
—Z, 14o wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be filled in by the individual proposing development)
5('e-
wry Hill SP.
Print or type name
Telephone number
Date

U. F. S., LLC
101 DOLPHIN WAY
BEAUFORT, NC 28516
252-728-7576
PAY Memo:
TO THE One Hundred and 00/100 Dollars
ORDER
OF:
CAMA
II0002&SSu' 1:0S3101S291:
WACHOVIA BANK, N.A.
MOREHEAD CITY, NC 28557
546 1 00
66-152/531
2855
DATE
Nov 4, 2005
AMOUNT
*****$100.00