58387_BERNICE PAGE TRUST_20120320

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❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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
El Rules attached.
A licant Name {
Pp
Address
City
Phone # ()_
Authorized Agent
Affected ElCW
AEC(s): El OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # ( )
❑ EW ❑ PTA ❑ ES ❑ PTS
ElHHF ❑ IH D UBA El NIA
❑ FC:
PNA yes / no Crit.Hab. yes / no
1
Subdivision
CityZIP
Phone # (,) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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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/ l-888-4RCOAST
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

eN
PAGE FARMS INC
252-393-8116
308 VFW RD
SWANSBORO, NC 28584
PAY
TO THE
� ORDER OF
smu�
�e Cape Carteret, NC 28584
FOF
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am
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00064378111
1497
66-1246/531
DAT C?�
DOLLARS«

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to W I (I64e,'s
(Name of Prope caner)
property located at t U q s►1�
(!,o6L
(Lui, Block, Road, etc.) [Doi
on in l i Doi , N.C.
(Waterbody) (To vn and/or County)
�W&
Applicant's phone#: 2"Mailing Address: e J(JO V T � )
c- w5q
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
/Y
Mailing Address
City/State/Zip
Telephone Number
.1 )Z/ z -
Signature Date
Date
(Riparian Property Owner Information)
�)ewa,
JD k ENN e Z,*7e-Print)o�Type Name
,5wead5 A 0
�g
Telephone Number
Date

i
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l I I I amPL.'s
(Name of Prope weer)
property located at i 0 (�16-hl
Block, Road, etc.)
on , in N.C.
(Waterbody) (To n and/or County)
Applicant's phone #: 2�52-M-911� Mailing Address: Lag V TAN [
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
ke 10&e �5 -/-D
(Information for Property Owner Applying
for Permit)
3DR'VFK) f6fid
Mailing Address
City/State/Zip
a5a- 3 3 - ?/I�
Telephone Number
.:._ ,d. =, JZ-. 7-43 -1a
Signature ^—� Date
(Riparian Property Owner Information)
Signs �re
-�Onl
f�. 0 . -&k /2.9 Print or Type Name
Ott Be+2T, nl C . 028539
Telephone Number
Date