55791_JUSTIS, MICHAEL_20100614

AS 11 o 16,8
❑GAMAW ❑ DREDGE & FILL
GENERAL PERMIT
I New .ElModification ❑Complete Reissue
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LlPartial Reissue
In,
Previous Previous permit #
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
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Address 407
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City v,
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State&-
ZIP Z•-', 5W
Phone # (i �) '?
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Fax # ()
Authorized Agent
Affected ❑ CW
❑ EW
XPTA ❑ ES
❑ PTS
AEC(s): ❑ OEA
❑ HHF
ElIH ElUBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes /no
PNA
yes / o'
Crit.Hab. yes / no
Project Location: County ( Tok fA
"191 c
Street Address/ State Road/ Lot #(s)
Subdivision �_ i 4 • ,1 -� f ! -
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City t� - f� ZIP
Phone # (� 52 )(a3�-- 15`t ` River Basin vl
Adj. Wtr. Body j>i') ^ S i Atk_ nat f/man /unkn)
Closest Maj. Wtr. Body 1 U Fy f-f 'r
Type of Project/ Activity f
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale: i _ 2U )
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Y
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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Shoreline Length
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: /Nei++)
Notes/ Special Conditions n)
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❑ See note
River Basin rules.
on back regarding
1
en r Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permi fficer gnature
tt 110
Issuint Date E pirat on Date
gej LA J"J Ohio 10A
Local PlanningJunsdiction Rover File Name

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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 Citv 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

A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date ,5--7-10
Applicant Name 1�' /�'� r✓ J t �j1'(� K
Mailing Address L j©� L(L (, j (BUT 0(2-t'C
MC- 2?1-34
I certify that I have authorized (agent) �Q �`7 N ' b t LC- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) �/ �L-ATTeD12� ,
at (location) ('ICI �./t LLl f U�(Z-t Vtl Ve
This certification is valid thru (date)
Signature '
sus
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to I C} }/� ('t✓�� �j��C 's
(Name of Property Owner)
property located at L ID-1 r✓ 1 L, t- I f UT 09- t VIP -
(Lot, Block, Road, etc.)
on ���C� �t�1� , in ICI=INN ,N.C.
(Waterbody) {{ ,,, nn�� (Town and/or County) (�
Applicant's phone #: ���'lX�V� MailingAddress: ��� Ll l �l� l/R -E
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.)
VI 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)
f�,U-rVg-e 0C PT LA
(Information for Property Owner Aping (Riparian Property Owner Information)
for Per 16--H--t"r-! (�ftP20f-
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Mailing Address
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City/State/Zip WNW
Telephone Number Telephone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 01 C pce-LJ U42TiC e 's
(Name of Property Owner)
� property located at 3-1 LI � L. I � -r 1 nn e- w-e-
(Lot, Block, Road, etc.) l_ on ���C,� (, ��L- , in -1'�IL-T� 6� - , N.C.
(Waterbody) f _ (Town and/or County) (�
Applicant's phone #: �� ['�� MailingAddress: L[ 0'� L (L L AT V 2 t tiE
0-Ew t"A
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.)
✓k 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)
f2 i FUiUice- (90A1- Lt
(Information for Property Owner Arming
fer Perm L Ef'C ►� C'l6 rl P�GR-
1-1 o155- c-lu l ouT f?fzt\/-F
Mailing Address
City/State/Zip
(Riparian Property Owner Information)
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FOCKS
4CKS DECKS N' DOCKS CONSTRUCTION, LLC 7321
1483 CRUMP FARM RD.NEW BERN, NC 28562 ; .—/�O 20ss-iiz/ssi
[phone] DL 8929001
Construction, LLC
PAY TO THE f : �,� 5.�,1� • - c ..._v�
ORDER OF arr
DOLLARS 8
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BRANCH BANKING AND TRUST COMPANY
800-BANK-BBT bbt.com
FOR R 1 C 7Ar
11200732L►i' i:053L0LL20:0005L95626296ul

4 � 4NG Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Michael Justis
Date: 7/6/10
Permit #: 55791 C
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
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Open Water
Dredge El Fill ❑ Both ❑ Other ❑O
1938
1938
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 ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanagement.net revised: 02/03 3 _