53084_FIELDS, JEAN_20090206

F�CAMA D DREDGE & FILL
tNERAL PERMIT Previls permit #
El New F]Modification El Complete Reissue E Partial R Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and t.,.l "R,,.uc.
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
J
Address 17 Street Address/ State Road/ Lot #(s)
City— State ZIP
7)(,) #
Phone #
Authorized Agent
Affected 0 Cw EIPW DES 0 PTS
AEC(s): El OEA 0 HHF 0 1H ED UBA El NIA
0 PWS: EIFC:
ORW: yes /.no PNA yes / no Crit.Hab. yes no
Type of Project/ Activity
I
Pier (dock) length
Platform(s)
Finger pier
(s)
Groin length
number
Bulkhead/ Riprap length___
avg distance offshore-1
max distance offshore --�
Basin, channel
cubic yards_
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other
----
I, -,I I
1�
Shoreline Length
— i
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
AID
A9—entor Applicant Printed Name
Signature P I ease read compliance statement on back of permit
Application Fee(s) Check #
Subdivision
City i'fo k, ZIP
Phone# River Basin
Adj. Wtr. Body (nat /unkn)
Closest Maj. Wtr. Body
(Scale:
10 1 IV V1 64A6uw Y V I
.AO5 tv
El See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing DateE)epira�lfibrybaie
Local Planningjuri!iZl—idi'on Rover File Name

s
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
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/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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

NO NR
North Carolina Department of Environment and Natural
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director
Date 2.3.d-
Resources
William G. Ross Jr., Secretary
FEB 4 2009
N�caren��.d ��ty OW
Name � �,,� i e1 S
Mailing Address 12.5 C nt'E ��-6\f e LA-� a�
I certify that I have authorized (agent) �✓% to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or coz
at (location)
This certification is valid thru (date)
Signaturi
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity1 Afifirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

I
ADJACENJ RIPARIAN PROPERTY OWNER STATEMENT
(FOR _q_1EASwf0ORfrYGPIrL�Ir�'GS,,,kTL1FT/BOATH0r15E) plIplVe_
I hereby certify that I own property adjacent to4"-)L-
's
(Nnme of Property O+%.ner)
property located at ae- ,
(Lot, Block, Road, etc.)
on
'tn N.C.
(j terbody) (Tolvn �ano�rCou�n�y)
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/ntoo "
must be set back a minimum distance of fifteen feet (IS,) from my f
waived by me.
I do not wish to waive the setback requirement.
4 2009
I do wish to lwaive that setback requirement.
------------------------------------•------------------ Morel -lead City DCM
------ ------ _ _______
DESCR:iPTi � -----------------•---
O. ANWOR DRA«'I1G OF PROPOSED DEVELOPMENT: -
(To Le filled in ikv iirdit idual proposing developlyle,rt)
s e Psi a,
fi
�I
Signature
/Z'87
Print or Type Name
Telephone N'urtlber
Date:

ADJACEi1;[ RIPARIAN PROPERTY OWNER STATEME11-
(FOR ,�lEt�iOORING PrLi�YGS/BO LIFTIBD.9 Tflt7rlSEj D�p�/e
I hereby certify that I own property adjacent to
° /43
's
property located at % -�s- Cr-Le. 4L'
(i 'nme of Property 0-,vner)
3
(Lot, Block Road, etc.)
on
(' terbody) ' to
, N.C.
(Town an or County)
He has described to Me, as shown below, the develop;lient he is proposing at that location,
and, I have no objections to his proposal. I understand that a pierintoonn iling;�boatli�„boatnots
must be set back a minimum distance of fifteen feet t J' from my waived by n1e. (' ") se
TM
I do not wish to waive the setback requirement.
— I do wish to waive that setback requirement. FEH 4 2009
.......
UESCRI PTtO� ----- �----------------------------------------- MOrehuaLl Ci �__�_
AhD.OR DRA«'ING OF PROPOSII~D DEVELOPMENT:
befilled in l r intfit,idiial proposing de►•elop»le,et) , IE\T;
s CPT,
Print c' Type Name
.2 Y Z_�
Telephone N'ttmber
Date: 6 9

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PH. 252-241-2636 66-1121531
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NEWPORT, NC 28570-6011
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