57049_HAGAN, THOMAS_20101223

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT `o/ Previous permit #
E]New ❑Modification ❑Complete Reissue OPartial 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
CityState ZIP
Phone # () Fax # ( )
Authorized Agent
El Cw
❑ EW 0 PTA
Affected
OEA
❑ HHF ❑ IH
AEC(s):
❑ PWS:
❑ FC:
ORW:
yes / no
PNA yes / no
❑ ES C PTS
❑ UBA ❑ N/A
Crit.Hab, yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # () River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
ISMINENIN
INEI
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Agent or Applicant Printed Name:
PermitOfficer's Signature }
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Issuing Date + Expiration Date,
r
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
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-28081 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

Applicant: Thomas Hagan
Date: December 23, 2010
General Permit #: 57049C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
719
719
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment. and Natural Resources
Division of Coastal Management
Beverly raves Perdue, Governor James N. Gregson, Director Gee Freeman, Secrelary
Date -
Applicant Name _ S�i�v As �-}AC AI J
Mailing Address _ 8005 ' F�- %Q IE�P_ L_1
_'I Eve --sep-0) I11L 28SG Z_
I certify that f have authorized (agent) L�'z2 �� i�-2�Sc.a'� to act on my
behalf, for the purpose of applying foi- and obtaining all C-AINIA Permits trecessar to
install or construct (activity) 'Pt E o__ a4- "ao�-: Lt F!--# ,
at (location) 3 0oS ` k \.,) rZ A_ t_ tJ
This certification is valid thru (date)
Signature'—
E 20 t \
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

ADJACENT RIPARL4 NN PROPERTY OWNED STATEMENT
(FOR A PIERNO PILINGS/BOA TLIFTIB0.,4 THO USE)
I hereby certify that I own property adjacent to % k vyK A s Pok &-^'Sj
(Name of Property Owner)
property located at 30o S R i vF-p LN /V�c►� 3E,QN n,� G S� 2
(Lot, Block, Road, etc.)
(Waterbody) N-C.
(Town and/or County)
Applicant's phone #:
Mailing Address: 3ooa R i tl Er2 i nJ
J` &J r3FO_N, �.iG 2854,
He has described to me, as shown below e development he is proposing at that location, and, I
have no objections to his proposal. I erstand that a pier/mooring pilings / boadift / boathouse
must beset back a minimum distan "Of fifteen feet (15r) from my area of riparian access unless
waived by me. (If you w" to W. ve the setback, you n=st initial the appropriate blank
below.) ,
I do not-,ish t aive.'
I do wish to wa that setback re rement.
------------------------Xvelopment)
---------
---------------
SCRIPTION AND/ G OF PRLOPMENT:
(7'© bed uz di ual propo
40
5 !C t 00 Co►s�, �E E1ciF�Jno,�
t/L
__------ -------- - - -- _ - 1 " too
-- -
- ---------------------------------------------------------
(In:formation for Property Owner Applying (Riparian Property Owner Information)
for Permit) .�
Mailing Address
NEW 35r- N
City/State/Zip
S� 633&5)0
Telephone Number
ignature Date
Signature
Print or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORI-NG PILINGSIBOAZLIFTIBOATHOUSE)
I hereby certify that I own propemy adjacent to 1 t Fvw A s %i�Ar&-st-./
(Name of Property Owner)
property located at 300 S -R 1 vF—p. L,-1 NccJ ar N � G Z BSIo Z ,
(Lot, Block, Road, etc.)
on _ -Fk6&J ► R t vep , in N E(.J Br..rtaJ , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address: 3QQS k 1 VE►2. L_�_ 1
Kai 'a FA_N , "J G 2,?56,
He has described to me, as shown below e development he is proposing at that location, and, I
have no objections to his proposal. I erstand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distant 'of fifteen feet (15') from my area of riparian access unless
waived by me. (If you with tow ve the setback, you n t initial the appropriate blank
below.) J?
I
I do wish to
-------------------------------
DESCRIPTION
(To
ive
that setback
----------
-----------------------------------------
(Information for Property Owner Applying
for Permit)
S T4 %qgA W
Mailing Address
W rmw t. rZtJ NC- 285h2.
City/State/Zip
ignature \ Date
G OF PROPOS
ual proposing
-------------------------------
EVELOPMENT:
5'y
106 'cawcAf-Te Etct w7l o N
s' x to' srd'mw•J
t " = too
I
--------------------------------------------------------
-
(Riparian Property Owner Information)
FF _
Signature
,�_�.
Print or Type Name
Telephone Number
Date

LAYOUT
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- http://gismaps,cravencounty,com/maps/map_print.asp?pid=8-204-3-063&minX=2579789.29642858&minY=489227,36607142,,, 12/2/2010

DR. THOMAS J. HAGAN 8053
612-A MCCARTHY BLVD. 252-633-3400
NEW BERN, NC 28582
66-30/53
DATE %0
PAY
TO THE Cl
ORDER OF
NK $ C"n
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4Z �DOLLARS
First Citizens
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firstcitizens.com
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