51892_KEARY, GREG_20071217

C�CAMA / ❑ DREDGE & FILL y_1V`V'I^Jl/ '/J�/ 4 �
GENERAL Rir-ERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Pa ' I Reissue Date previous permit issued
i
As authorized by the State of North Carolina, Department of Environ ent and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 9L 1�
❑ Rul s'ttached.
Applicant Name
Address
City
Phone # O
Authorized Agent
Affected El CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
Stater- ZIP
Fax # O
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
EJ ES ❑ PTS
❑ U BA ❑ 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
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale: )
_
f l
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift .
Beach Bulldozing
Other
-
--
i
I
I
i
)
,F
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes lno
Waiver Attached: 'yes, no
A building permit may be required by:
Notes/ Special Conditions
I
-
f ' `' `
1
_
I
See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature. Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature j
Issuing Date Expiration Date
cL
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 252-808-2808/ 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

ADJACENT RIPARUN PROPERTY O'PVNlIER STATEMENT
(FOR A PIER/MOORING PIL7IVGSIBOA7ZII TIBOATHOU,SE) Ihereby certify thatI own properly adjacentto LtC4 1e . �M,452-67p)
(Name of ]Pro r#y Owner)
property iocated at IUD Ulfft tl
—P�•
(Lot, Block, Read, etc.)
C�-� , in_Ar� hoc Tad iq` -,(6 CO;N.C.
(Waf�erbody) (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 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 DEVELOPMENT:
(To bed In by in al proPVS(ng development)
E M \ / So.ndlers
signature
Print or Type Name
_�03• �}2�•z132 �2• �7I • z7D�
Telephone Number
Date:

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DEC-12-2007 WED 04:15 PM CRRDIOTHORRCICSURGERY 7404546354 P. 01
North Carolina. Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr.. Secretary
Date I , Ll-LT
Applicant Name
M.siilingAddress CI M , X. l:A1 a ci-
I certify that I have authorized (agent)t SCI"cltL�� C to act as my
behalf 'for the purpose of applying for and obtaining all CAMA Permits necessary to
.t_tN
install or construct (activity)
at (location)
'Phis certification is
Signature
(date)

ADJACENT RIPARIAN PROPERTY O9VNER STATEMENT
(FOR A PIER/MOORING PILIIVGS1B0A7UFT1B0A7H0USE)
I hereby certify that I own property adjacent to eact_ is
e of Prole Owner)
property located at
on V lwSon'S Cr?_e_�
(Waterbwy)
(Lot, Block, Road, etc.)
in Araaav� c yoam 1 i c o Co. -N.C.
(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 pilings / boatlift / boathouse
must be set back a minims m distance of fifteen feet (15) from my area of riparian access unless
waived by me. (If you wash to ware the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do elvish to waive that setback requirement_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To hued in by hmW idwiproposing *m1opment)
Keagy
= 5 x70' ,
m -I Cl X�
x 12
3 40.5'
- .
-Ito/
Signature
Print or Type Name
Telephone Number
Date: Z -2 G �
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PRESCOTT BROTHERS INC
141 TARA TRL
GRANTSBORO, NC 28529
PAY
TO THE
ORDER OF--k
4056
' 66-30/531
DATE 472
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