57987_ANDERSON, STACEY_20110610

nCAMA J ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
L�New , ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorizes` 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
El Rules attached.
Applicant Name
Address 3-)O TG..r-lrte Dr.
City State ZIP01146
Phone # (`)',�
Authorized Agent
Affected ❑ CW O EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City k�- `^-,crc i 17r i e ZIP
Phone # RiverBasin
Adj. Wtr. Body r 'r'V44F )QvP (nat /man /unkn)
Closest Maj. Wtr. Body ocV'' I. -A
�■
:.� � . -�1■■i�i■■61■■■Vie■
r 1■■■®■ItONUlYMEN
iiio��i�i�
■■Ill!■■■■!R■■
or Applicant Printed Name Permit Officer's Signature
Signature ** Please read compliance statement on back of permit ** Issuing Date
Application Fee(s)
Check# Local Planning Jurisdiction
Expiration Date
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
Iandowner(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/ I-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

DivisionNC of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Stacey Anderson
Datt: 6/15/11
Permit #: 57987C
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
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Shallow Bottom
Dredge ❑ Fill ❑ Both El Other O
1344
1344
_Jemp
Open Water
Dredge El Fill ❑ Both [I Other 0
1513
1513
�Co
Dredge ❑ Fill ❑ Both ❑ Other Fx1
500
500
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 ❑
5 - - 0 ;: 1- COAT :; w% .ncC'q;! #, MMI� emea!3. - revised, - fir' o

U.S. Postal Service,.
CERTIFIED MAILT. RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
IN
M
-0
$0.44
$
0684
Postage
m
$2•95
� Certified Fee
02
p Receipt Fee
1-3(Endorsement
(Endorsement Required)
Postmark
Here
s2.30
O
f0.00
- Restricted Delivery Fee
1-3(EndorsementRequired)
Q�
f U Total Postage & Fees
$ $5.59
04/25/2011
O
PS Form 3800, August 2006 See Reverse for Instructions

Certified Mail Provides:
A mailing receipt
A unique identifier for your mailpiece
A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First -Class Mails or Priority Mail®.
■ Certified Mail is not bailable for any class of international mail.
■ NO INSURANCE COVERAGE ,IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
r For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is
required.
■ For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsement "Restricted Delivery'.
■ If a postmark on the Certified Mail receipt is desired, pZase present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
PS Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047

BER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
DCLV ii e'li L
A. Signat e
X ❑ Agent
2! -� ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7010 0390 0000 3609 3141
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540
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Sender: Please print your name, address, and ZIP+4 in
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RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIOOATLIFTBOATHOUSE) JUN 6 2011
I herebycerti that I own property adjacent toAj"co, � p p y � _ BEM CITY
(Name of Property Owner)
property located at l6- 521--,J —D1- ,
(Lot, Block, Road, etc.)
onSo in F7�, e ►'cZ N. C.
^� (Waterbody) (Town and/or County)
Applicant's phone #: '�OggNl.ailing Address: 'Si O-L � �v
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 be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
clGC
l 0 J �c k
�{ 15
-� - oar-
(Riparian
K
M
Frmt
---------------
rmation)
Name
Telephone Number
Signature Date Date

CONSTRU7TION
Emerald Isle, NC
Owner Carl Heverly
252-241-6020

RECEIVED
JUN 6 2011
DCM-MHD CITY
om 1� rnocy c on c e r n
Car 1 IAtvey-ty b6e*-x Lon-yra c-� A--O 64- l CL
a_ ptr- cA -t � Lt u 2, Sour d D r O it, i n, E► near alk
S , N(� a*J, � S a�XA nor; Z,-P-A k� Me, +0 of
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Siv�cere,l�

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� --,- � ,• - _' Cho ;t.-� ��, .,�
-- _ "�- RECEIVED
I
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JUN 6 2011
DCM-MHD CITY'

PAY
TO THE
ORDER OF
HEVERLY CONSTRUCTION
[phone]
7306 CANAL DR
EMERALD ISLE, NC 28594-3007
First Citizens
Bank
DATE 66-30/531
342
C�
r
$
DOLLARS
firstcitizens.com 7 SJ
FOR _—. /----
II100 20 6 So I:0 S 3 LO❑ 300I:00 3 4 L 2 30 30 S 2u'

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oticauraNORTH CAROLINA
DIVISION OF COASTAL MANAGEMENT
Site Inspection Summary
PermitNo.: PermitType:
57987C General
8402 Sound Dr.
InspDate:
8/18/2011
Description
Dock
Comments:
RepsName:
Davenport
Dock complete.
Violation District:
L MHCDO
PermitteeName:
Anderson, Stacy
InspType:
Monitoring
Township:
El
Printed On: Thursday, August 18, 2011 RecordiD: 7195
County Name:
Carteret

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