Karlsson, Ulf

NCAMAY 14 DREDGE & FILL
GENERAL PERMIT Previous permit #
NNew ElModification ElComplete Reissue0ardal 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
W Rules attahecl.
Na
me Project Location: County
I On Address V) Street Address/ State Road/ Lot #(s)
City talte&
mxii_1 IF -ZIP. 312
Phone # Fax # Subdivision
Authorized Agent City ZIP
El CW Phone Affected ❑NEW }PTA OES 0 PT4 River Basin
AEC(s): 1-1 OEA El HHF O'IH 0 UIBA 0 N/A Adj. Wtr. Body(f)'!e (nat /m--a-n7)/unkn)
0 PWS: El FQ
Closest Maj. Wtr. Body t:)
ORW: yes no PNA yes kno' Crit.Hab. yes Cno)
Type of Project/ Activity
Pier (dock) length dl
Platform(s)
11 V1 L. L
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel 4'
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
7'
Other
�Shoreline Length YV
EJ
no
no
�SAV: not sure yes no
Sandbags: not sure yes no
I't,
Moratorium: n/a yes no
Photos: yes no
-Waiver Attached: yes
1 1 1
A building permit may be required by: I I A!2
c,
1<
Notes/ Special Conditions
I -
A
Agent,& Applica� Printed Name Permik Officer
'-` ..,,...w-.•mac.,.,. �-�.-✓-^�'�'�'�'". ---
Signature "Please read compliance statement on back ofiermi Issuing ate
Application Fee(s) Check#
El See note on bick
v r
(Scale:
ig River Basin rules.
lio (' (7/!/

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:
0 Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
0 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/ 1-888ARCOAST
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

91--IZFO�
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 6 - 3 ' 13
Name of Property Owner Applying for Permit:
Q L 4 14,o rZ I S So►a
Mailing Address:
L/
XMVEp
JUL 112013
bCA2-4�M CITY
I certify that I have authorized (agent) M V D 8 ,- e-V 1 W--,1 t�, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) nG
w A¢nn
at (my property located at) 14-c- S 1
This certification is valid thru (date)
G3i3-i^
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to CL-T-- V'A'R- --SSo rJ 's
(Name of Properly Owner)
property located at ` � ) W � ,��'�
(Address, L Block, Road, etc.)
on � A wn9 L , in , N.C.
(Waterbody) (City/Townand/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
-2 o k2ax 3
44cL'LCD5
RECEIVED
JUL 112013
Dcm--mm CITY
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) ("a- ent Property Owner Information)
Si ature
O�-r
Print or Type Name
(QW
Mailing Address
KS Nc•
2-5 72`�6n osc
Telephone Number
Date
Print or Type Name
1n' 3L' lei
ailing Address
City/State ip
1,Fe-7
Telephone Number
Date
(Revised 6/1 &2012)

I hereby certify that I own property adjacent toV�4 14, A e- s
{II (Name of Property Owner)
property located at ! I U I le Vi
(Address, Lo�Block, Road, etc.)
on Z A rj A in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
L( ,� �� v 'p��eD�� v�C)� r• L,Ff
1
b� S
\r ��'00
k`
A w D'f�s 1,1 r.,o 0- C2,
2ay2'0-e- 3
gy-e-L,ttn5
WAIVER SECTION DC1tZ MHD CITY
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
e A _
Signature
Q C.-,c I( li 2 S5o ^)
Pri t or -IVDe Name
119 Qf.Ae19-S\(,
Dr1vG
ding Address
>! S IQ —
26
Cif /State/Zi
S , (-�
©-- q
Telephone Number
S•2•13
Date
tature
,e--hnt4?C" schrn
-Print or Type N me__ II 1
L I-7 bi LTs-ps,n
Mailing Addre s
Ci /StatelLip
y0- o(66- - 133-2 CT)(
Telepho a Number
,-12 2/13
Date
(Revised &18/2012)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Karlsson
Date: 7/26/13
General Permit #: 62746C
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 ❑
400
400
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.nccoastaimanagement.net revised: 02/03/10