Anderson, Clinton

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 [)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 FN 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/ 1-888ARCOAST
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

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Clinton Anderson
Date: March 24, 2011
General Permit #: 57178C
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
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
SB
Dredge ❑ Fill ® Both ❑ Other ❑
1,600
160
ow
Dredge ❑ Fill ❑ Both ❑ Other ®
120
120
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 ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10

RECEIVED
MAR 2 3 2011
DMMOCffy
North 'Carolina, Department of Eaviron-ment and Natul ai Resources
Division o, Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secret,ry
Date 3= I ; ) I .-
Applicant -CIW47 Q
Mailing Andress � O+rwuv� e-1
I certify that I have autborized (agent)
t' }✓I� W5—� to aci On M-
behalf, for the purpose of applying for and obtaining all CANIA Permits necessary to
install or construct (activity) � "�
at (location)
his cer, A cation is �°alild tinrn (d e)
'Signature `�

dRCENED
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT MAR 2 3 2011
I hereby certify that I own property adjacent to. C C tXrl-14J Ak1 *� A) is J)CM-UnDci7y
(Name of Property Owner)
property located at LA-N*V%LA) JT" C 1 'Gl e ,
(Lot, Block, Road, etc.)
on MJ A0r5 a-p( t-�C, , in (?14 KfinLd-, 5tf WS e iq l , N.C.
(Waterbody) (Town d/or Coun )
Applicant's phone 3a2-5/37 Mailing Address:
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)
1 /L
I q54Kri t4
��
for Property Owner
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
(Riparian Property Owner
qC 0-"� &1-4,
Lkigiature
Print or Type Name
oil 9
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT �
I hereby certify that I own property adjacent to.
C L lt�TarJ-�il�lp.sb 'sr, I�
(Name of Property Owner)
property located at U R (3p(L0 ar C t CC-L,C ,
(Lot, Block, Road, etc.)
on MA t&ikh15 c4Y 04 L , in � l 1� �1`l a iL S4bg"
(Waterbody) (Town and/or County)
Applicant's phond§- 63b?-�5137 Mailing Address:
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)
\QV
cko>
�4��D�
54)
for Property Owner
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature
Date
(Riparian Proper wner In{Oijnation)
Signature
Print or Type Name
Telephone Number
Date