46719_BROWN, SCOTT_20061011

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11 CAMA El DREDGE & FILL
GENERAL PERMIT Previous permit#
E]New 1-1 Modification L]Complete Reissue El Partial Reissue Date previous per nik 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.
Applicant Name Project Location: County
Address
City
State ZIP
Phone #
Fax #
Authorized Agent
El Cw
El EW El PTA El ES El PTS
Affected
AEC(s): El OEA
El HHF El lH El UBA [I N/A
El PWS:
El FC:
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City - ZIP
Phone# River Basin
Adj. Wtr. Body (nat /man /unkn
Closest Maj. Wtr. Body -
Type of Project/ Activity
(Scale: V
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
SAM not sure yes
Sandbags: not sure yes
Cn.)
Moratorium: n/a yeS
Photos: yes
(66) 1
Waiver Attached: yes
A building permit may be required by:
See note on back regarding River Basin rules.
Notes/ Special Conditions
X,
Agent or Applicant Printed Name-,.;>
Signature Please read compliance statement on ba&VVeWR,1
?006
--Jjrmit Officer"s Signature
D1%A'
lsOffig—Dife' Expiration Date
A'
Application Fee(s) Check #
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:
❑ 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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
i 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:
TNTtOP E . W-4D 16 5Ck
l -FEN E 8L Si
NJ
A. Sii9pature
u l C
X (c(Je v� .�d�' L
❑Agent
❑ Addressee
B. Received by (Printed Name)
C. Date of Delivery
Cl 16c
6
(t
D. is ery Address different from item 1?
❑ Yes
IfA, inter delivery address below:
❑ No
3. Service Type
,' Certified Mail ❑ Express Mail
El Registered ❑ Return Receipt for Merchandise
O Insured Mail ❑ C.O.D.
4. Restricted Delivery? (EXtra Fee) ❑ Yes
2. Article Number
(Transfer from service la 7005 1820 0004 2100 0662
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
• Sender: Please print your name, address, and ZIP+41 this box •
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Game of Property Owner)
property Ioczted at �j �Q./-1—�L �� I�
X467--
(Lot, Bloch, Road, etc.)
on_ lit ��' , i n , N . C'
(Waterbody) (To)yn and/or ounty)
He has described to me as shown belo,,v, the development he. is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AN-D/OR DR- A f NG OF PROPOSED DEVELOPMENU
(To be filled in by individual proposing developmentl, &t,,-
i
'v
SiQ u're `
r
Print o. Typc'N-ame
a2-
Tel epho-,e Number
Date:
-29-

PAY
• TO THE
ORDER OF
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PRESCOTT BROTHERS INC 3533
141 TARA TRL
GRANTSBORO, NC 28529
DATE 66-30/472
531
DOLLARS
A I JfENS 472
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