60186_BUTKUS, THOMAS_20120430

❑CAMA / U DREDGE & FILL
GENERAL PERMIT
UNew ❑Modification 'L-- 'Complete Reissue ❑Partial Reissue
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
. -T. 1 •-,
No. 60186
Previous permit #
Date previous permit issued
Applicant Name t'\ t`? fy l 1 Ili I FNI Project Location: County
r,
Address ,._•7 _yP 3j� r . +1 Street Address/ State Road/ Lot #(s)
0 Rules attached.
ity •:�, '4x 00
State_ lIr
ZIP
Phone #%(f1
..wer.y
Fax #
Subdivision
Authorized Agent—ffl
j
%1� -q('
City
ZIP_
Affected - CW
C EW
PTA 71 ES
ilH
7—PTS
--
Phone # (_ )
"J
River Basin
OEA
AEC s :
HHF
_ ; UBA
N/A
V'"
Ad' Wtr. Bod- `'
qy
}�
l (nat /man /unkn)
- PWS:
- FC:
Closest Maj. Wtr. Body
ORW: yes / no
PNA
yes 1 no Crit.Hab.
yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number ++ — ------- T-- -
Bulkhead/ Riprap length f ? X
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_ ___
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length [
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: _ )
__ See note on back regarding River Basin rules.
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Issuing Date
Application Fee(s) Check# Local Planningjurisdiction
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
�I Tar- Pamlico River Basin Buffer Rules ❑ Other:
D 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/ I-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)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Name of Property Owner Applying for Permit:
Mailing Address:
17"1. 9 � WATN" W WIN
In r
I certify that I have authorized (agent) 5 to act on my
finis aIISCcr� n� �ruc� ic�1 > L C
behalf, for the purpose of applying for and obt 'nmg C MA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) iaol
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: -1 '1r )mn S
Address of Property: 1�3 1ind� c�Yl , 1 V� Q �P f "P] i I9 cc
(Lot or Street #, Street or Road, City & County) Applicant phone #: Mailing Address: � n i GI1 N of f 51r.
1 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, with dimensions, must be provided with this letter. ---7
SC -ill
I have no objections to this proposal. I have objections to this proposal. RGQF—R5E
If you have objections to whatis being proposed, you mustnodly the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you 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.
(Prop y Owner Information)
Signature
Print or Type Name
Mailing Address
Ara nobo P- s( C c ' I0
City/St te2ip
Telephone Number
41
Date T
(Rip 'an Property Owper information)
Signature
Print or Type Name
Li I z, !yJ4 Or (,I B,,)-,.2
Mailing Address
Areyc noel Al. d�ss'sl�
City/State2ip
,;;T�,2--a49 - Je-23
Telephone Number
Date

\nsU� cW . M' a f 2,6 moY(Oe gre,60- Wooden
bulkY�nd

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: k-h =o �:' t z 1V1 AS
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 06a — aqq 651 Mailing Address L�(n-.�,s 1' Iahl . -Di
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, with dimensions, must be provided with this letter.
_ I have no objections to this proposal. I have objections to this proposal. 1=v Rb
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you 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.
(P-rroppeerty Owner Information)
Signature
Print or Type Name
.�� �rYttQli`�111� �IJf,
Mailing Address
A f' , is 0 olgr-)\ r)
City/S te2ip
Telephone Number
Al lD /Q-
Date
(Riparian Property O er Information)
Si atur
Print or T e Name
S) Toil--- &v--f f Dr
Mailing Address
City/Stat Zip
Telephone Number
'�d /o /0
Date

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