55203_GOTARD, HANK & EDIE_20100209

❑CANA / 17, DREDGE & FILL
GENERAL PERMIT Previous permit #
❑ffeW ❑Modification ❑Complete Reissue ❑Partial Reissue %bate previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Res urce
and the Coastal Resources Commission in an area of environmental concern pursuant to 15 CAC 1
s attached.
Applicant Name 1 Project Location: County '-1����� �--
Address ` 1� Street Address/ State Road/ Lot #(s)
City r1 _State `'�Of IP�As� ? f C
Phone # ( �ax # I(—)
Subdivision "
Authorized Agent {��_ �/�-ri }e _ City 7 ZIP
Affected ❑ CW ❑ EW PTA ❑ ES ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body t�, ;l ri nat man unkn
ORW: yes / no- ! PNA yes / 6D Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity v�(�''_ 1•
Pier (dock) length
Platform(s)
Finger pier(s) :_a
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other
t
Shoreline Length 1 0 t I
SAV: not sure
yes
no -v
Sandbags: not sure
yes
no
Moratorium: n/a
yes
o
Photos:
yes
n
Waiver Attached:
yes
no
A building permit may be required by:
Notes/ Special Conditions
9
Agent or Applicant Printer Name
Signature Please read compliance statement on back of permLit **
Application Fee(s) Check #
I II--qL'
(,) tl_r , - ---
❑ See note on back regarding River Basin rules.
0 ) � rAoncAzi 1 4- _`:-4rb( (
The time period requirement for this
development is suspended until 12-31-
2010, pursuant to Senate Bill 831. The
Permit Officer's Signature effective date of expiration for this
permit is1
Issuing Daatte Expiration Date
Local PlanningWisdiction 1, 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
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.
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

NC Division i act Computer Sheet
Applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)__amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
-80 - 03 -.; 1- t A a'T` :; .w _ _nccoasta1r ne rrt.net revised: 02103.110

COLONEL HANK GOTARD 3967
EDITH L. GOTARD
137 NORTH SHORE DRIVE / 66-30/531
BEAUFORT, NC 28516�� ( Date 137
LePaytothe��0('Ir of �- r $ U
-dollars � �,e�.••
First Citizens ,p
® Bank
firstcitizens.com
For_
i:0531003001:001317346602u' 03967

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date—; // //d -
Name of Property Owner Applying for Permit:
RECEIVE®
Mailing Address: FEB 9 2010
� 7 Ao.0 �4 J � 10pfVfP Moreh epdCityDC.
wool A) Cw tL If 4T4
I certify that I have authorized (agent) M if ke "4C to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
;1
* err
$00
at (my property located at) % 3 % 4/. �N •
This certification is valid thru (date) q1111ej.
Property Owner Signature
MY
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

■ Complete items 1; 2, and 3: Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
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:
-7� f
1
A. Signa r
j
X Agent
❑
Z❑ Addressee
B. Rqgived by (Printed Name) C. Date of Delivery
-25-66
D. Is delivery address different from item f? El Yes
If YES, enter delivery address below: ❑ No
RECEIVED
II FEB 9 2010
3. Se WV@pd City DC► j
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
i
(Transfer from service label) 7009 2250 0002 8347 617 9
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 y
1)

UNITED
4. 's R E• s MID..44
• Sender: Please print your name, address, and ZIP+4 in this box •
110 -e /ko

ADJACENT RIPARUN
V 7.0"G"'TY OWNER STATEMENT
STATEMENT
ATHOUSV
I hacby certify that I own property Aacent to uAr4 . + EDIt gz
(Name of Property Owner)
property located at 13 7 Now S° 7.)e Ttocit.
(I.ot, Blocky Road, etc.)
on I`44.7W �C'I � , in Cd4a:TZWWrT" , N.C.
(Waterhody) (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 gierhnooring
must be set back a minimum distance of fifteen feet (151 from my area of riparian access unless
waived by me.
r,
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement. FEB 9 ZQ��
DESCRIPTION AND/OR DRAWING OF PROPOSED DEYFLOPMEhiT: Morehead 04, DCM
(To bed in by inrtivirtxnl proposing d miV )
r-
T- _ -4--
a �
�.Cl �> AloKSu ram'
Ta'%�t.rz-q v
e
W4L-s—e %-,4y 'WtDe / ),Z-
Pant or Type Name
e3o` Lt�ti►Er _ q a�
Telephone Number
Date:Jg&, oP 7 v

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOOR17VG PLUNGS✓BOATLIFTIROATHOUSE)
I hereby certify that I own property adjacent to "AP4K + E G Gramez 's
(Name of Property Owner)
property located at 137 1Vb&734 SM%Le PC C 7-ce. .
(Lot, Block, Road, etc.)
on P'/*d. W RI I EM , incr (cA= war !'!"y , 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 use
must be set back a minimum distance of fifteen feet (I5� from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
RECEIVED
I do wish to waive that setback requirement.
ER 9 2010
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be, idled in by individual proposing development) ivrorehead Gif�� DGA�
j &q. q' >
vv/lt+G$'W ,
/-W, [jv,.IG-
i Str p o6 wri
3 � aL.f}TF'c�kL.
7of
V)
Signature
Print or Type Name
Telephone Number
Date:

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER
FORM
Name of individual applying for the permit;
Address of property:
(Lot ar street:X. 5U-eei of raetn --
-5�
(city & County)
I hereby certify the I own property adjacent to the above referenced property. The
Individual applying for this permit has described to me (as shown on the attached
drawing) the development they are proposing. A description or drawing, with
dimensions, should be provided whit this letter.
I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of C� �t I cF�VE®
Management, 400 Commerce Ave., Morehead City, NC 28557 or call (252) 808-'2'8Q&9
within 10 days of receipt of the notice. No response is considered the same ase Z��Q
Objection if you have been notified by Certified Mail. headctyOCAM
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags mast be set back a minimum distance of 15" From my area of riparian
access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
I do wish to waive the 15' setback requirement
do not wish to waive the 15" setback requirements
>ignaiure
'rint Name
.elephone number with area code
Date