Falls Jr., Ralph L

Q?CAMA / ❑ DREDGE & FILL � f: 6223 '
ENERAL PERMIT Previous permit#
t4ew E]Modification ❑Complete Reis artial Reissue` Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources C mmission in an area of environmental copcern pursuant to I SA NCAC
� � f i t � \ %� � .,l❑ ules attach
PP _ 4_ 't , y 1 County licant Name.. , _,rt Project Location:
Address I l c s, f Street Address/ State Road/ Lot #(s)_ l
City { j ! s .� j States ZIP (^��. t ��� I
T .
Phone # ( ) ! I IX
Fax # ( ) ! 4" Subdivision
!Authorized Agent ;Y7)3,r1lCity r \ ; (��1i ? I ZIP
❑ CWEW TA ❑ ES ❑ PTS Phone # () ` ""' ver Basin,
Affected ❑ OEA ❑ HHF LJ IH ❑ UBA ❑ N/A rr '
AEC(s): El PWS: Adj. Wtr. Body 1 t_ k.l �i' ' w t ;� ((nat /man /unkn)
❑Tn
_T ` 3
Closest Maj. Wtr. BodyORW: yes /\no' PNA yes/Crit.Hab. yes /nor �C
i
Type of Project/ Activity i�. "t ! `.. (JJ i ( ^l u� �7� �� t . (� ) 1 i a. 1
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boatramp - i
Beach Bulldozing
Other t ('
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes
Moratorium:. n/a yes n i
'Photos: yes no i I
Waiver Attached: yes ° no l
A building permit may be required by: I 1' 1 ` k(ti(4• ( -
j /i (
Notes/ S ecial Conditions
�I
Scale: --
jJ (..Sege+ ote on back reRudi jng River Basin rules. )
—i1,9
r
'Agent or Applicant Printed IN a t!p'
j j
PermitOfficer s Signature
Signare rPlease read compliance ftatement on back of permit"
Issuing Date t J' r1 {jfj
KJ
Expiration Date
Application Fee(s)
Check #
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 [)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:
0 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/ 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)
Revised 08/09/06

Applicant:
Date:
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
to m acts)
FINAL Sq. Ft.
(Anticipated. final
disturbance.
Excludes any
restoration
and/or temp
impact amount)__temp
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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A ALT, X- WA
NCDEN .
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date 4' /Wh3
,R>rGENEI�
Name of Property Owner Applying .for Permit:
APR 2 3 2013
Mailing Address: DCM-MHDCM
_ A
ko� Oilli I�L� Vtv'e
I certify, that I have authorized (agent) i t 1 �c>vtc� S
r to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)NQ—W bz' "' -ut 0'-V" . per,,,, .sy ,
at (my property located at)
This certification is valid thru' (date) 0— ) q
Property Owner Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.necoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer.: 50% Recycled 110% Post Consumer Paper
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4/19/2013 3:05 PM

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CERTEMD MAM—RETURN RECEIPT REQUESTED
DI ISION OF COASTAL YIANI- ACEIV=
_ADJACENT RIPARLMN PROPERTY OWNER N- O=ICA'iIOIrVWArV ER I
FORAM
Name of individual applying for the perrttit: �ia--t.� i `C
,kddress of property:
( Lot orsU=W, street of road)
(City & GAMY) /
I hereby certij�r 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, should be provided T-t ith tills letter.
V I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave.} Morehead City; NC.28557 or call [phone]
fidthin 10 days of receipt of tbe- notice. No response is considered the same as no
objection ifyou have been notified by Certified Dail.
waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lit, or
sandbags 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
appr griate blank below.) I do wish to waive The 15' setback requirement
I do not wish to waive the 151 setback requirement
UCUVISD
Signature D e
�� APR 2 0 M3
Priet Larne I)CM--MHA CITY
Telephone number with area code
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Apr21 13 03:12pp Ralph L. Falls, Jr.
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1-919-821-1074 p.1
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C R� AIT, —RETURN RECEIPT REQUESTED
17rvmoPT of COASTAL IiT&NACMMENT
AMACENT ROAMAINF.ROF",W OWNER NO=CA-ffOM'WArVRR
FORD
Aiame of individual applying, for te,
Address of property:
I hereby ceriily that I own property adjacent to the above referenced property_ The
individaaI apply; for this permit bas described to me (as shown on he attached
drawivaJ the: development they are proposiagg .A. description or dmwhqa,-- with
dimensions, should be provided TAM this letter:
c
I have no objections •to this proposal
Ryon have objections to vAmt is being proposed, please write the division of Coastal
Mtanagemen , 400 Comm emeAve, !Morehead QlYi I4C28557 or call (M) 808-2N8
w thin 10 days of receipt of 76e notice '-No response is considered the same as no
objection iiyou have been notified by Cerf'i&ed Afaii.
waiver Section
I understand that a pier, dock, mooring, pilings, breakwater, boa#h©nse, lift or
sandbags must be set back a minimum distance of 15, From .my area of riparian
access unless waived by me. (3fyou wish to waive the setback, you mastinitial the
appropriate blank below.)
V ;wry wish to waive the 15" setback reauiremmt
Print
f do not wish to waive the 1:7 setback requh-dmert
elD
r.,m ba+_��
number wait area code
RECEIVED
C • APR 2 3 2013
DCM MHD CTfY
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