Clingman, William

62260
¢. i�CAMA / ❑ DREDGE & FILL Q/
'GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissu artial 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 attac ed.
Applicant, N e : `ti i �t t'� y Project Location: County !E r f 4�= _ p�
_ g
Address 1�'r_ ,^' ✓ r� ,� Street�Address/ State Rd/ Lot #(s)
f C;CityState
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Phone # ( `c-) /� C f Fax # (=— ' Subdivision �1 ��-��jl
Authorized Agent City t""\ r ZIP
Affected ❑ CW -1d EW �' PTA ❑ ES ❑ PTS Phone # ( .r)_ _'." River Basin,, �,
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A j / �f j �ti:(�(,'/ , / nat� /man /unkn
AEC(s): Adj. Wtr. Body _ ! } ( )
❑ PWS: ❑FQ / r
Closest Maj. Wtc Bod
ORW: yes /(� PNA yes o Crit.Hab. (y�� no y
1
Type of Project/ Activity t� rIr" {`•r ; r. r �'�y ' '� (, rl
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max distance offshore
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JAge�torApplicant_P_rintedName - Permitoffic� sSign re
SignatureePleaseheadcompliancestatementonbackofpermit"' Issuing Date
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'Application Fee(s) Check# Local Planrnngjurisdiction

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, certifythatthis project is consistentwith 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 howto complywith 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

t NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Clingman
Date: 5-28-2013
General Permit #: 62260C
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
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
144
144
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888.4RCOAST :: www.nccoastalmanagement.net revised:02/03/10

10 WA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date - - +
Applicant Name 1111L4/1f -Is% &I-Al�
Mailing Address ��`/ elyyA"�ie ffX Cs/
Wi dSl-7)4/ 41 &. , -�'%e4
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) kD P t T-) n ,%l i ' —t- 4G-A- n d Cl-i Qe) e- K- ,
at (location) 5--8
This certification is valid^ (date) ©g 3 tt 3
Signature x
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] Intemet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer- 50% Recycled 110% Post Consumer Paper

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: lkI',-e4Ihl1 $'
Address of Property: �3/,O� j� /4��D/l/ 4'A,5 /5,
(Lot or Street #, Street or Road, City & County) C.rty—T �u�/ry
Agent's Name #:
Agent's phone #:�
Mailing Address: /* 4,-6v7
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.
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.nccoastalmana-gement.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, lift, or groin 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 Owner Information)
I
Signature
Print or Type Name
Mailing Address
City/State/Zip
3 3 L r I'Af4 3-L5 0
Telephone Number
Date
(Adjacent Property Owner formation)
Signature
Print or Type Name
Mailing Address
City/State/Zip
3 3 G, -- 9-1 4. -- q Ll o o
Telephone Number
k 5-*�-3-/.3
Date
Revised 611WO12

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED.
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: /y/Gz
Address of Property: Al-C -
(Lot or Street #, Street or Road, City & County) L"WA/Ty
Agent's Name #: ✓�� r,--7 ;gee o
Agent's phone #:
MailingAddress:
irle .741�;7
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.
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.nccoastalmanagement.neticontact 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, lift, or groin 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 O er Information)
Signature
Print or Type Name
�qw
Mailing Address
City/State2ip
33G -- • f� —�.s�
Telephone Number
Date
(Adja
cent Property Owner Information) y
Signature
Print or Type Name
Mailing Address
City/State2ip
x 2.5-.2-V7- 73S09
Telephone Number
Date
Revised 6/18/2012

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