54146_HIENON, DAVID & CARA_20090611

❑ CAM^ / ❑ DREDGE & FILL ` /1 41 4 9-�-'
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial 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
City
Phone # ()_
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # ( )
❑ EW ❑ PTA
❑ HHF ❑ lH
❑ FC:
PNA yes / no
❑ ES ❑ 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 gnat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale: )
_
1+
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel —.
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no r
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
'�_ i '✓ .
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❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signatures Please read compliance statement on backof permit
-
Application Fee(s) f��%-�iCf�ecF f
Permit Officer's Signature
l
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
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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

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NCDENR t
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date �; T % b - n�
Applicant Name 11ol C� 141eW50AJ
Mailing Address
4tu,4
I certify that I have authorized (agent) l (� �q-$� Lam, to act on my
behalf, for the purpose of applying for and obtaining all LAMA. Permits necessary to
install or construct (activity) �-� �f t' �tj
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at (location) 1 n ►'b� t'tf I Pr-;c- crz-- /
This certification is valid thrumsate) :T--"j A)rl 4-C-5-
Sigua
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recyclosd 110% Post consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 141 V,yQ ntarJ is
(Name of Property Owner)
property located at I ,/i 14140r11"tc Al ,
(Lot, Block, Road, etc.)
on i`,'hH/(,W���hwPt �t�a� :4wPSo in Air /W/ A#i ,?r , N.C.
(Waterbody) (Town and/or County)
Applicant's phone JVI) 7114-a333 Mailing Address: 11107 Tavet Ccr L
�c�� M • ,�f-� ii.�. d � Bey
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 pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
Ag I do not wish to waive
I do wish to waive that setback requirement.
---------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
l alp Fgi'Prn ZJ 61
Mailing Address '
City/State/Zip
(a- A)908-a U
Tele ho e Number
1�_ Y-®
Signature Date
(Riparian Property Owner Information)
Signature
� urn 1�qe- e-
Print or Type Name
2f'z ?2 yLclz
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOAT IFT O THOUSE)
I hereby certify that I own property adjacent to IS
(Name of Property Owner)
property located at l7 G Ako%i. Aj Ve
(Lot, Block, Road, etc.)
on &1JfAwr 6,vlm42 � , in j6, ,- Z�f� S�ic�,r , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #P -/ R�8-223a Mailing Address: /aid T ✓Pr4 Lam kV
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 pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELQPMENT:
(To be filled in by individual proposing development)
----------------------------------------------------------------------------- ---
(Information for. Property Owner Applying
for Permit)
1 T -ter 4JA.
Mailing Address
�W,ktj /&111a7
City/State/Zip
_"S �e�-a33a
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Signature Late
(Riparian Property Owner Information)
All"�� P
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Signature
4�1� M C /V
Print or Type Name
-I/ /-)Z
Telephone Number
Date

First Citizens
Bank
First -Citizens Bank & Trust Company
Raleigh, North Carolina
Ply to the NCDENR
order s,f -- d, $200.00 14
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Dollars
Allen Sasser
Remitter I
05-10070R (12/06)
III
603438 12599MOCK1
II'054704 20111 1:053 L00300i:980799499011°
11

Year, Month, Day Post Office U.S. Dollars and Cents
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Address
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