54317_HOFFMAN & KOZLANSKY, LLC._20090720

El CAMA / El DREDGE & FILL C
GENEF41. PERMIT .Pre\&us permit #
I
EINew DKodificailon []Complete Reissue ElPartial 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
FXR,1les attached
-
Applicant Name 00(1
Address 00 1�2n r C1-1 J-1
City j State N� zip - -'o
Phone # (—) Fax
Authorized Agent
(Yj # 'l C, & -C
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5LEw 4irm DES El PTS
Affected
AEC(s): 0 OEA
EJ HHF 0 1H El UBA D N/A
D PWS:
OFC:
0 R W: yes / no
PNA yes I no Crit.Hab. yes / no
Project Location: County_
Street Address/ State Road/ Lot #(s)
Subdivision 4 ri `o
City ZIP
Phone # 0" le
Adj. Wtr. Bodyr C)C- CRiver Basin ir M-, (nat /man /unkn)
Closest Maj. Wtr. Body f-
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gen or Applicant PrinteO Name
Signature Please read compliance statement on back of permit
Zoo"
Application Fee(s) Check #
Permit Officer's S�niture
Issuing Date' Expiration Date'
Cq -I et
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PII,INGSIBOATLIFTIBOA MOUSE)
I hereby certify that I own property adjacent to
property located at v 0
/�/��f� •.}/./.' (Nam//e of %Property Owner)
�(Lot, Block, Road, etc.)
on in ��E2, ✓/�% , N.C.
(WBterbody) own 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 understated that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (151 from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be, filled in by individual proposing development) I v SrK
six"
p n CSz or
i y �ec (�
r
fli `Jf6��
V 'N-
o m gnature
r
Print or Type Name
Telephone Number
Date: '( - 3 u - 0
Fq
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ADJACENT RIPARIAN PROPERTY OWNVTER STATEMENT
(FORA PIERIMOORING PILING"OATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to #6 r�-7
(Name of Property Owner)
Property located at e
(Lot, Block, Road, etc.)
on 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 piling s/boatliftlboathouse
must be set back a minimum distance of fifteen feet (15`) from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
--------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
a/,e,-4-,, (-t e 3o2-r
Signature i J
Print or Type Name
'3 3 C -- (_ �t 4 - o v'yT-�
Telephone Number
I—) - ? / c q,
Date: -5 I

JUL--17-2009 03:33 PH N A E
7283966 P.01
JAN-07-2009 12:34 PM HOE 7283966 0 C
WED
JUL 1 7 2009
North Carolina Department of Environment and Natural Resources _;ad City CCh4
Division of Coastal Managemant
Michael F. Easley, Govemor Charles S. .Eons, Director Wilhom G. Ross Jr.. Secreiaru
Applicant Name / Q N -7� (�-I ,I ' �Q
Mailing Address 3d t7 j I—ee4' e -
I eertff� that I have authorized (agent) 11q- Z O to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) 7 Y—AC
This certifi
Signature
400 Commerw Avenue, Morehead City, North Carolina 28557
Phone. [phone] FAX: [phone] Intemet: www.nccoastalmanagement,not
An Equal OppmU* l Aftnsh a Action Fffqloyer - W% Racyaed \ 10% Pose Consumer aver
JRN-07-2009 13:33 From:7283966 IO: Page:003 R=92%

NOE CONSTRUCTION & SERVICES, INC. 'r" 1 245
P.O. BOX 2012 PHONE: [phone]
66 1246/531
BEAUFORT,NC 28516 "
Z2 ate -
Pay to the
gOrder of ::
Dollars 8
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DL3/7
BeatAOrt, NC 26516 ;
For
1:053 l L 24661: 00077099il' L 245
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