59321_BRUNK, SHARYN_20111020

CAMA /-, DREDGE & FILL
'~ GENERAL PERMIT Previous permit#
[]New ❑Modification ❑Complete 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 15A NCAC
❑ Rules attached.
Applicant Name-.._-- Project Location: County
Address_ — Street Address/ State Road/ Lot #(s) - -
City--- ------___--.—
_ State
ZIP 1
Phone (--- )_.--
------ --- Fax
Authorized Agent
Affected ❑ CW
❑ EW ❑ PTA ❑ ES
❑ PTS
AEC(s): ❑ OEA
C HHF ❑ IH -J UBA ❑ N/A
❑ PWS:
=FC.
ORW: yes / no
PNA yes / no
Crit.Hab. yes / no
Subdivision
City ZIP
Phone # (`) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
I �
i•
Platform(s)
i
Finger pier(s)
Groin length
-
number _
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
I,
i
cubic yards
J
Boat ramp ~
t
r ti .i
Boathouse/ Boatlift
1
Beach Bulldozing
t
Other
I
Shoreline Length7PKI r
sure s no not s e
SAV: Y
Sandbags: not sure yes no —
I
`- I ;.
Moratorium: n/a yes no I
--{
—
Photos: yes no _ + ;
Waiver Attached: yes no
A building permit may be required by: '"
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Issuing Date
Check# Local Plan ningjurisdiction
Expiration Date
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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules
❑ Neuse River Basin Buffer Rules
❑ Other:
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 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

VAUGHAN & ASSOC. CUSTOM BUILDERS INC
[phone]
128 COTTONTAIL RUN
NEWPORT, NC 28570
PAY
m �fTO THE
ORDER OF
i
4118
66-301531 .
/ 137
DATE
DQ LLARS
FIRST CITIZENS 137
n A j�j7l FirsFh..d Ci Bank & Trust Company
�y � � I� Morehead G ty, N.C. 28557
w 5 www.firstc't'z. s.COM
® FORS•-,4 !�a ..
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) " V l of V4 �,� h h to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 4vl�-t,� /I 1— 4
at (my property located at) LD 1
This certification is valid thru (date) �
��-c 01,�
Property Owner Signature
Date

<'-'ERT-fREQ,VAfL - RETURN RECEIF T REQUESTED
DEVI&OH OF COASTAL MANAGEMBNT
ADJACENT RIPARkAN PROPER-r . y OVtffqFR NO-nRCATpOW,WAIVER FORM
Name of Property Owner /2
k
Address ffi.Pm 7- 4
PLGt aT Strom* Sk&A or Read, Cfty &G-ounW
f -7 - 07
I hereby ce-Affy that f, am pmpeedy adjacwfG ff?e above refLarenced pe r4iMu pm. rV- 71 he j af
apPlYing 50- F this pernwt hlas desaibed fa Me as sha%Wn ae, tfte allached. dravMgffie davL-bpfmn#
they are pmposines_ A description or dMv&h rasnq, d4nenbe sions, must vrovided v&h fts t efter-
z
!I bane no cbjwtom, to this pra-vosal- [have Obyactims to dfis praposa
ff youhave0b;l0cff-amw
MCK) m wnftn-g As 19 dairs Gf re�pt of fts aafice- Coatact sniFe . rsa.8 for Dcu o4wces is
avaft&e atx aster c.r ac dcmJftm 4ar by caWrig 1-638-4.RCGAST- So
res s se is cw-sMwed &a amm iTs r,,-- c4i----6on fj= have by cer&fma Mad
WAFVER SECTION
'lundei -staad liat a pier, dock-, inawing pi-Fmgs, bneakmtier, boatause., or fift rest be set bark a
minimam distarice off Wftm, mi-f area off nzpaftn ass urjess wahed by Tm. (if You W,35b to
w2iive the SetbaCk, VOL, Must inifial thie appropiate wank beiaw)
�, dc. viish towsive j-?,e IS' seback mqui7 --n-feim
i do n-at VASh 1w waive the 15' Setback fequiramierzL
(Property CPwm.r WormnatioM
!L
Flnfe or Type Namse
Maib7g Add-ess
Tet-.&Ime "NLlater
(Ri n Property Owmar I fbmmt�;.aw
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a
or TWA -Wawle
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MaIS Adahrms
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONiWAIVER FORM
Name of Property Owner
e - 12 - 44P-kA iWP,,<- eL,&
Address of Property: 4 -S�?t,' 23 % -lUotj�,
(Lot or Street #, Street or Road, City & County)
D12; --e ;4Ic )-?�
Applicant phone #: � _ f 0 -�-7e Mailing Address: 7 J ! —
Q
/.� I�✓
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description' or drawing AtAh dirr�ensrons: must be provided tivith this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, youmust notify the Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastafmangementnet/contact dcm him or by calling 1-888-4RCOAST. No
response is considered the same as no objection ifjou have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement_
(Property © r Information)
6� on
Signature e- X - RQX4VJQ A- ZtC-1 4e
Print or Type Name
Mailing Address
Citwstate/Zip
,Z36 ,-,f i'2-0i?,P
Telephone Number
*�-OF LO
Date
(Riparian Property O ner Information)
Signatu AA �
Print &dType Name
MaYing Address
Citylsta p
`/11 610
Telephone Number
Date