55275_KILLMEIER, LAWRENCE_20100310

❑CAMA / ElDREDGE & FIL r. b
GENERAL PERMIT Previous permit #
C]NeW ❑Modification El Complete Reissue ElPartial Reissue Date previous permit issued
A 1) ,
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 i 1
El Rules attached.
Applicant Name
Address
City State ZIP
Phone # (`) Fax # ( )
Authorized Agent
o Cw ❑ EW ❑ PTA
Affected
AEC(s):
❑ OEA ElHHF fD IH
❑ PWs: ❑FC:
ORW:
yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length it V;
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boat
❑ ES ❑ PTS
❑ UBA ❑ N/A
Beach Bulldozing
I
Other
'
Shoreline Length I
t .i_ —a
SAY: 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
Crit.Hab, yes / no
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # () River Basin
Adj. Wtr. Body gnat /man /unkn)
Closest Mal. Wtr. Body
t
(Scales
'• v > E c
c
V
E ;z ,_
o
-
C O
t to _� V
L
o o r M c
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s= v
of
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❑ See note on back regarding River Basin rules.
The time period requirement for this
development is suspended until 12-31-
Permit fficer' Sin e J 2010, pursuant to Senate Bill 831. The
6• i!
effective date of expiration for this
permit is
Is ate f
E
Local Plan ningJurisdiction Rover ileName

J
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/ 1-888-4RCOAST
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

AMA / ❑ DREDGE & FILL NO 5527C,
GENERAL PERMIT Previous permit #
NXe""w ❑Modification ❑Complete Reissue El Partial Re%NatuReso
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment andes and the Coastal Resources Commission in an area of environmental concern pu'. t I
AC / 1� t
es a ached.
Applicant Name_, la j, y� �,�j y� �r Project Location: County " f
Address Street Ad Jdrre'ss/ State Road/ Lot #(s)
City_.���,%� �— State ZIP -C T
Phone # # ( ) Subdivision
Authorized Agent
City i J
Affected N-ew' isZEW '
mar DES ❑PTS
Phone # L- `'
'River
AEC(s): OEA ❑ HHF
❑ IH ❑ UBA 0 N/A
i�
Adj. Wtr. Body
❑ PWS:
`�
OFC:
/
ORW: yes / PNA
yes / o Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
ZIP
r5 (Scale:
Pier (dock) length , �
Platform(s)-
+' 1 i J
Finger pier(s) Jr
Groin length Cnumber
-
-�
Bulkhead Riprap length.l �(��i�. IlL}' I%i1/j�j U r7y
avg distance offshore_
max distance offshore.
Basin, channel - --- - - - - - _ O
- - - -- -- N
C
cubic yards bD E
ai G C
Boat ramp _ I _ L C y c.
I-
Boathouse oatlift --- ------
Beach Bulldozing
Other
Shoreline Length
SAY: not sure yes o'
Sandbags: not sure yes o
Moratorium: n/a yeseno
Photos: yes!
Waiver Attached: yes
A building permit may be required by:
Notes/ Special Conditions
-,
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
776V
Application Fee(s) / A _ Checlk#
_
-
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•=
3110
PIt! 11x 1 rU
❑ Seepo e�n back regarding River Basin rules.
A A A , r .,
The time period requirement for this
development is suspended until 12-31-
Sign ure 2010, pursuant to Senate Bill 831. The
effective date of ex iration for this
permit is }�

7:••WA f
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
March 10, 2010
Lawrence Killmeier
1316 Fairbanks Ct.
Jacksonville, NC 28546
Dear Mr. Killmeier:
Attached is General Permit #55275C to install a 85x5 Pier (dock), 100x5xl Bulkhead and a
Covered Boatlift at 152 White Oak Bluff Road, Stella, NC.
In order to validate this permit, please sign the permit as indicated. Retain the white copy for
your files and return the signed yellow and pink copies to us in the enclosed, self-addressed
envelope. If the signed permit copies are not returned to this office before the initiation of
development, you will be working without authorization and will be subject to a Notice of
Violation and subsequent civil penalties.
We appreciate your early attention to this matter.
Sincerely,
Heather M. Styron
Coastal Management Representative
lsb
Enclosures
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

MAILING ADDRESS:
P.O. BOX 09
AYDEN,NC
28513-0009
March 2, 2010
LAW OFFICE OF
STACEY B. BAWTINHIMER
235 THIRD STREET
AYDEN, NC 28513
Email: [e-mail]
CAMA /Morehead Division
400 Commerce Avenue
Morehead City, NC 28557
Re: Concern of Adjacent Riparian Property Owner
Lot 5, Block B, White Oaks Bluffs Road
Swansboro, NC
Dear Sir/Madame:
RECEIVED
MAR 3 2010
Morehemri City DCM
TELEPHONE [phone]
TELEFAX 252-439-0269
Attached is the Adjacent Riparian Property Owner's Statement for the above
referenced property along with the proposed drawing by Lawrence Killmeier.
As indicated we do not waive the setback requirement. We also want to voice our
concerns about potential erosion along our adjacent property line which may be caused
by the proposed stone bulkhead. As I have noted on the map, our property has riprap
and with the proposed stone bulkhead, we can envision that there might be significant
erosion at this point on our property line.
Therefore, we would request that CAMA require some sort of erosion control to
be put in place to protect our property prior to approval of this bulkhead.
if you have any questions, please do not hesitate to contact inc at 252-349-3273.
Sin 1
S cey awti imer
A
Enclosures
cc: Lawrence Killmeier w/enclosures

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 1��.�IGFr� i�cFLi�/L is
(Name of Property Owner)
property located at T ce 15
(Lot, Block, Road, etc.)
on C i� oe✓ , in , N.C.
(Waterbody) (Town a d/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/boatlif (boathouse
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.
1 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Attached you will find a sketch of the proposed seawall and dock as improvements to Lot 5,
Block B, Section One, White Oak subdivision (152 White oak Bluff Rd). The proposed 4'
seawall will be placed above the high water line and tie into the existing Riprap to the west and
the wooden bulkhead to the east. Clean backfill will be used to create a gentle slope from the top
of the seawall back to the existing bluff.
Additionally, you will see a proposed pier/dock extending approximately 100' into the river.
The proposed structure will consist of a 5'x 85' pier connecting a 15'x 20 dock and a boat lift
with a 15'x 25' cover.
(Applicant Information)
% 14 CT
Mailing Address
City/State/Zip
Telephone Number
Date
Owner Information)
Print or Ty# Name
dsA-3Y91-3A73
Telephone Number
C.
Date '

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Applicant:
Date:
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
teme impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact 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
redge ❑ Fili Both ❑ Other ❑
n-j
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill [I Both ❑ Other
Dredge ❑ RII ❑ 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 ❑

Lawrence Killmeier
1316 Fairbanks Ct
Jacksonville, NC 28546
February 22, 2010
Heather Styron
Division of Coastal Management
400 Commerce Ave
Morehead City, NC 28557
Subject: White Oak Bluffs S/D, Block, Lot 5 (PIDN #536704507099)
Dear Ms. Styron
RECE1VEG
FEB 2 4 2010
MOrehepcj City ®CM
I am applying for a general permit to build a seawall and dock at 152 White Oak Bluff Rd,
Stella, NC 28582. After discussing the permitting requirements with you and completing the
pre -application site visit, I believe the attached documents meet the application requirement. If
there are any additional items necessary to begin the property improvements please advise.
A check for the permitting fees is enclosed totaling $600 ($400 for the seawall and $200 dock).
A copy of the Adjacent Riparian Property Owner Statements forwarded to the property owners
of 150 and 154 White Oak Bluff Rd along with a copy of the certified mail receipt is also
included.
I am most easily reached via email during working hours at [e-mail] or
phone [phone]. After hours my home number is [phone].

Lawrence Killmeier�
1316 Fairbanks Ct for®v,
Jacksonville, NC 28546 b®oc,Qfk
February 17, 2010
Gaary Bawtinhimer
3675 Roundtree Rd
Ayden, NC 28513
Subject: Adjacent Riparian Property Owner Statement
Dear Mr. Bawtinhimer
I want to introduce myself as the new property owner of 152 White Oak Bluff Rd. We spoke
briefly when I called to confirm your mailing address and the necessity to send you the enclosed
paperwork. Included is the Adjacent Riparian Property Owner Statement required by the North
Carolina Division` of Coastal Management and a sketch of the proposed property improvements.
As I understand the Coastal Area Management Act (CAMA) requirements you have 30 days to
provide any objections or concerns to the Division of Coastal Management. My permit
application is being submitted to the Morehead City office at 400 Commerce Ave, Morehead
City, NC 28557. Additionally, I'm available at [phone] work or [phone] home to
address any concerns or recommendations you may have.

Lawrence Kil meiero � .2 Z010
1316 Fairbanks CfV r®hg��
Jacksonville, NC 28546 cxtkoc4f
February 17, 2010
Edward Feege
154 White Oak Bluff Rd
Stella, NC 28582
Subject: Adjacent Riparian Property Owner Statement
Dear Mr. Feege
We have discussed briefly my plans to begin improving the property at 152 White Oak Bluff Rd.
Permit requirements direct that I send you the enclosed paperwork. Included is the Adjacent
Riparian Property Owner Statement required by the North Carolina Division of Coastal
Management and a sketch of the proposed property improvements.
As I understand the Coastal Area Management Act (CAMA) requirements you have 30 days to
provide any objections or concerns to the Division of Coastal Management. My permit
application is being submitted to the Morehead City office at 400 Commerce Ave, Morehead
City, NC 28557. Additionally, I'm available at [phone] work or [phone] home to
address any concerns or recommendations you may have.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
property located at
(Lot, Block, Road, etc.)
(Name of Property Owner)
's
on ----- , in , 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 pilings/boatlift/boathouse
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)
Attached you will find a sketch of the proposed seawall and dock as improvements to Lot 5,
Block B, Section One, White Oak subdivision (152 White oak Bluff Rd). The proposed 4'
seawall will be placed above the high water line and tie into the existing Riprap to the west and
the wooden bulkhead to the east. Clean backfill will be used to create a gentle slope from the top
of the seawall back to the existing bluff.
Additionally, you will see a proposed pier/dock extending approximately 100' into the river.
The proposed structure will consist of a 5'x 85' pier connecting a 15'x 20 dock and a boat lift
with a 15'x 25' cover.
---------------------------------------------------------------------------------------------------------------
(Applicant Information) (Riparian Property Owner information)
.lfailing {ddress Signature
01)' Smite %ip Print or Type .Vume
Telephone Number Telephone .Vianber
Ucrte---�---- - �- ------ Date

7679
Col, LAWRENCE E. KILLMIGUEF, JPL
BUT 11 M. KILLMEIER 68-7497/2560
1316 FAIRBANM CT- 2 2 fi:�4. 2-DI 0
JACK'30NVMLrl, NC 28546 DATE
DOLLARS
NAVY
FEDERAL O'er
Credit Union 3
2 560 7 9 7 L11: ?G 1013t. 20
OCIIIINT �IIUMI� g

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Af " A
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
March 10, 2010
Mrs. Stacey B. Bawtinhimer
PO Box 09
Ayden, NC 28513
Dear Mrs. Bawtinhimer:
Dee Freeman
Secretary
This letter is in response to your letter dated March 2, 2010, regarding your concerns about the proposal by
Lawrence Killmeier to install a keystone bulkhead located above the NHW contour adjacent to 152 White Oak
Bluff Road, in Stella, Carteret County. The proposed project has been determined to comply with the Rules of
the Coastal Resources Commission (71-1. 1100 ), and as such, a permit has been issued to authorize the
development. I have enclosed a copy of the permit, as well as the relevant statutes.
If you wish to contest our decision to issue this permit, you may file a request for a Third Party Hearing.
The request for a hearing will be considered by the Chairman of the Coastal Resources Commission. The
hearing request must be filed with the Director, Division of Coastal Management, in writing and must be
received within twenty (20) days after the disputed permit decision is made. I have enclosed the applicable
forms and instructions that must be filed prior to that deadline. Please contact me at [phone], if you have
any questions, or if I can provide any additional information.
incerely,
JaTes H. Gregson,
Cc: Ted Tyndall, Assistant Director
Heather Styron, Field Representative
400 Commerce Avenue, Morehead City, NC 28557
Phone: [phone] \ FAX: [phone] Internet: www.hccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer
No thCarolina
Nato -rally

TetAMA / ❑ DREDGE & FILL
GENERAL PERMIT
N?
5527
❑Modification ❑Complete
Previous permit #
ew 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 I SA NCAC � < r
Applicant Name-. �1,`� ocle, hnj
Y- R.
Fil es a ched.
Project Location: County Y j 'At `�
Address > •
Street Address/ State Road/ Lot #(s)
�,��
City .)"s-. ��— State ZI P ` /� �+
f fi,.`
, 7
�, -•
Phone # -- ax # {_)
Subdivision
Authorized Agent
City___ ZIP
DES ❑ PTS
Affected,
Phone # (C )L G� '- t i River Basi
AEC s : OEA ❑ HHF ❑ IH p UBd ❑ N/A
{)
Adj. Wtr. Body C ��,
J .r
❑ PWS: ❑FC:
t�
,
nat man unkn
ORW: yes / � PNA yes / 0 �1 Crit.Hab, yes / no Closest Maj. Wtr. Bodyri
Type of Project/ Activity
Pier (dock) length
Finger pier(s) j
Groin length
number
Bulkhead �Riprap lengths
avg distance offshore. �__
max distance offshore
I I
Basin, chaQnel - -- —}-- ; _-
L_ ---
cubic yards -
Boat ramp
Boathouse/ oatlift
Beach Bulldozing
Other • - — I- -
Shoreline Length DU
! ��
SAV: not sure yes o'
S db
an ags. not sure yes o
Moratorium: n/a yes
Photos: yes no
Waiver Attached: yes no i ___r._ " I i
A building permit may be required by: `
Notes/ Special Conditions ~ ., c , llt
VQ
Agent or Applicant Printed
Signature** Please read compliance statement on back of per
tm-i�
t
Application Fe s) Chec #
J
1
\� I
1. Z
' f
❑ See pote 9
3110
I
a
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to
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oCn o
C .4-
on > �-
N
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;= ns
a C. >
f6 O
u
r 0. R
.... A 'C
back regarding River Basin rules.
i tj ! � .. f-v �.1�' dL4
The time period requirement for this
development is suspended until 12-31-
Signature 2010, pursuant to Senate Bill 831. The
effective date of expiration for this
permit is , I-- I /
Name

SECTION ,1100 - GENERAL FERINJIT FOR CONSTRUCTION OF BULKHEADS AND RIPRAP
REVETMENTS FOR SHORELINE PROTECTION IN ESTUARINE AND PUBLIC TRUST WATERS AND
OCEAN HAZARD AREAS
15A NCAC 07H .1101 PURPOSE
A permit under this Section shall allow the construction of bulkheads and riprap revetments for shoreline protection in the
public trust waters and estuarine waters AECs according to authority provided in Subchapter 07J .1100 and according to the
Rules in this Section. This permit shall not apply to shoreline protection along the oceanfront or to waters and shorelines
adjacent to the Ocean Hazard AEC with the exception of diose shorelines that feature characteristics of the Estuarine
Shoreline AEC. Such features include the presence of wetland vegetation, lower wave energy and lower erosion rates than the
adjoining Ocean Erodible Area.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124;
Eff. March 1, 1984;
Amended Eff. July 1, 2009; April 1, 2003.
15A NCAC 07H .1102 APPROVAL PROCEDURES
(a) An applicant for a General Permit under this Subchapter shall contact the Division of Coastal Management and request
approval for development. The applicant shall provide information on site location, dimensions of the project area, and the
applicant's name and address.
(b) The applicant shall provide:
(1) confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objections to the proposed work; or
(2) confirmation that the adjacent riparian property owners have been notified by certified mail of the
proposed work. The notice shall instruct adjacent property owners to provide written comments on the
proposed development to the Division of Coastal Management within 10 days of receipt of the notice,
and, indicate that no response shall be interpreted as no objection. The Division of Coastal
Management shall review all comments and determine, based on their relevance to the potential
impacts of the proposed project, if the proposed project can be approved by a General Permit. If the
Division of Coastal Management determines that the project exceeds the guidelines established by the
General Permit Process, DCM shall notify the applicant that an application for a major development
permit shall be required.
(c) No work shall begin until an on -site meeting is held with the applicant and a Division of Coastal Management
representative so that the proposed alignment may be marked. Written authorization to proceed with the proposed
development shall be issued if the Division representative finds that the application meets all the requirements of this
Subchapter. Construction of the bulkhead or riprap revetment shall be completed within 120 days of the issuance of the
general authorization or the authorization shall expire and it shall be necessary to re-examine the alignment to determine if the
general authorization may be reissued.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124;
Eff. March 1, 1984,-
Amended Eff July 1, 2009; October 1, 2007,• September 1, 2006; January 1, 1990; December 1, 1987.
15A NCAC 07H .1103 PERMIT FEE
The applicant shall pay a permit fee of two hundred dollars ($200.00) for riprap revetments sited at or above normal high
water or normal water level, or a permit fee of four hundred dollars ($400.00) for riprap revetments sited below normal high
water or normal water level. The applicant shall pay a permit fee of four hundred dollars ($400.00) for bulkheads. Permit fees
shall be paid by check or money order payable to the Department.
History Note: Authority G.S. 113A-107; H3A-113(b); 113A-118.1; 113A-119; 113-119.1; 113A-124;
Eff. March 1, 1984;
Amended Eff. October S, 2009; September 1, 2006; August 1, 2000; March 1, 1991.
47

(k) If one contiguous acre or more of property is to be excavated or filled, an erosion and sedimentation control plan shall be
filed with the Division of Land Resources, Land Quality Section, or appropriate local government havirg;urisdiction. This
plan shall be approved prior to commencing the land -disturbing activity.
(i) For the purposes of these Rules, the Atlantic Intracoastal Waterway (AIWIi'✓) is considered a nanaral shoreline.
(m) Construction authorized by this general permit shall be limited to a maximum shoreline length of 500 feet.
History JNote; Authority G.S. 113A-107(a); 113A-107(b),, 113A-113(b); 113A-118.1; 113A-124;
Eff. March 1, 1984;
Amended Eff. July 1, 2009; Aprd 1, 2005; December 1, 1991; January 1, 1989; December 1, 1987.
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DCM FORM 5
PETITIONER'S NAME
COUNTY
FILE NUMBER
(Petitioner leave this line blank)
THIRD PARTY HEARING
REQUEST ON
CAMA PERMIT DECISION
PLEASE TAKE NOTE that the undersigned, 'a person affected by the decision of (check one):
a Local Permit Officer acting on a CAMA Minor Development Permit
application; or
the Division of Coastal Management, Department of Environment and
Natural Resources, acting on a CAMA Major Development Permit
application or CAMA General Permit application
hereby requests permission from the Coastal Resources Commission to file an appeal pursuant to
N.C. Gen. Stat. § I I3A-121.1(b) and N.C. Admin. Code tit. 15A, r. 7J.0300 (Please attach a
copy of the perrnit application decisions. If you cannot obtain a copy gf'the permit application
decision, please provide the name of the pernsittee, the project location and the permit number.)
Requests are reviewed by the Chairman of the Coastal Resources Commission to determine
whether a liearin` shoulcl he grained. '1'lic determination of whether to �orant a hearing' is in the
sole discretion of the Chairman. N.C. Achnin. Code tit. 15A, r. 7J.0301(b).
For this application to be complete, the Petitioner must address each factor listed below on a
separate sheet of paper. You must address these factors before your request will be reviewed.
The Chairman's decision to grant a hearing will be based on whether the Petitioner:
(1) Has alleged that the decision is contrary to a statute or rule [N.C. Gen. Stat. §
113A-121.1(b)(1)J:
(Please cite the statute or regulation allegedly violated by the permit decision.)
(2) Is directly affected by the decision [N.C. Gen. Stat. § 113A-121.1(b)(2)): and
(Please describe how you are directly affected by the permit decision.
Persons directly affected by a decision iflclisde, but are not limited to:
(a) any owner of real property in the vicinity of the property to
be developed who can shore that the proposed development
is likely to have a significant adverse effect on the value
and enjoyment of his property: and
(b) any person who can demonstrate a history of .substantial
use of public resources in the area directly affected bN- the

development when the development is within or touches
upon an area subject to the public trust.)
(3) Has alleged facts or made legal arguments that demonstrate that the request for
the hearing is not frivolous [N.C. Gen. Stat. § 113A-121.1(b)(3)].
(Please summarize the evidence or arguments you will present at a
hearing in support of your appeal.)
Based on the attached responses to the above factors, the undersigned hereby requests a third
party hearing.
Date Signature of Petitioner or Attorney
Name of Petitioner or Attorney
Address
City State Zip
Telephone Number
NO1'liS: 'fills request must be served on the Director, Division of Coastal Management, at
the address shown on the attached Certificate of Service Form, within twenty (20)
days of the disputed permit decision. N.C. Gen. Stat. § 113A-121.1(b). Failure to
do so constitutes waiver of the right to request a hearing. A copy should also be
sent to the Attorney Generals Office, Environmental Division, at the addresses
shown on the attached Certificate of Service Form.
Approval of a Third Party Hearing Request allows a petitioner to file a contested
case petition with the Office of Administrative Hearings within twenty (20) days
of receipt of the Chairman's Order. N.C. Gen. Stat. § 113A-121.1(b).
Denial of a Third Party Hearing Request is a final agency decision which may be
appealed to the Superior Court in the county where the property is located under
N.C. Gen. Stat. § 113A-121.1(b) and Chapter 150B, Article 4.

CERTIFICATE OF SERVICE
I hereby certify that this Third Party Hearing Request has been served on the State
agencies named below by depositing copies of it with the United States Postal Service with
sufficient postage for delivery by first class mail or by personally delivering copies to the named
agencies.
Original served on: Director
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
and a copy served on: Attorney General's Office
Environmental Division
9001 Mail Service Center
Raleigh, NC 27699-9001
This the day of ,
Signature of Petitioner or Attorney
Updated: June I. 2005