Ricks, Georgia

•., ,&x CAIWIA / ❑ DREDGE & FILL ` 52169 C
GENERAL PERM1 Previous permit#
f�New ❑Modification El Complete Re Partial 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 I SA NCAC ( V l
Rules attached.
a
Applicant Name% I G Project Location: County �� /C
Address P ?C �l {�^ �"� Street Address/ State Road/ Lot #(s)
StateV( ZIP
Phone # 6 i`) `a `41Fax # (_) Subdivision
} c
;Authorized Agentirl'/j✓' r✓i"tr ; f City �`�'fe ��� T� r ZIP %
t _ . l 1 ffi �
❑ CVN ,a EW �p PTA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 1 G r- } v u r+ !i� na man unkn
❑ PWS: ❑ FC:
ORW: es�/ no . PNA es Closest Maj. Wtr. Body It' fc:-+r c,
y y ,no Crit.Hab. yes / no
Type of Project/ Activity I > z, a
(Scale: )
Pier
Plad
Fing
Groi
.I Bulk
Basis
Boat
Boat
Beac
Oth(
Shor
�SAV:
"Sand
Mo
Phot
Wai
,
�N■q■11�■
■
mom
i length
■
��i�■
number
■n�����r�a��ir
aNONE
�■
ore
max distance offshore-
N=.HEE
MW
cubic yards
ramp
Bulldozing
:-I
p:.
�line Length
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditionr� j � G •` c r j/ �• 1 i
Agen or Applicant Printed Name Permit Officers Signature {
Signature Please read compliance statement on back of permit Issuing Date yr Expiration Date
ApplicationFee(s) Check#Local Planningjurisdiction 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, 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 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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
�(D 3g7 - yea
Date I _ -2) �BCr.M
MAR 2 © W3
Name of Property Owner Applying for Permit:
pCM -j4HD CITY
�eo �St a �. • �.�cl�s
Mailing Address:
?. d. -60y il5gg,
EM.e(-a Ld L5 (,e, K-C
I certify that I have authorized (agent) 1,3vu— QW& to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property
3•`f-/-3,
Date

/�rhpT tt items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this cans to the back of the mailplece,
or on the front if space permits.
Article Addressed to:
x5-
JC)---7 Cou�61 Club
DUVk4aAA,
.L(P Agent
D.;1s delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
4
3. ice Type
rtified Mail ❑ Express Mail
G-Aegistered ❑ Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
f]139.3 9946 5857
(Transfer Frvm`s�
es• esWtfe mReceipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mai
Postage & Fel
USPS
Permit No. G-10 '
• Sender: Please print your name, address, and ZIP+4 in this box •
7eorgla L. Nicks
Post Office Box 4549
-Emerald' Isle, N.C. 28594

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Fie 0v-tG-./ L. v- �5 is
I arro of ProKrty Owner)
11
property located at FY � -b �Ac(-a.(d-?lam 07 - I)/ --
(Address, Lot, Block, Ro d, etc.)
on �Oc�e CStd , in IG IGfle �C , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I o do .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
�74
JV5VED
MAR 2 0 2013
DC:1:1'IHD CITY
WAIVER SECTION
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.
do not wish to waive the 15' setback requirement.
(Pr 'perty Owner I
4- U. w V r —to J L-1
"'re
�C.d Isle
City/S t� Cp 2 g J50t1 f
Telephone Number
(zs'21 5WI
Date
(Adjacent Pr perty Owner Information)
Oatur
r
(Revised 6/1 &2012)

■ tompietd items 1, 21and'3: Also complete
tzeni 4 if, Restrlcted,Dellvery Is desired..
■ Print your name and address on the reverse`
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
At/ V5. I <,A 5car L ti%
T 134 Luc cd PI � De
GW�fa-td t.V Zg '4
`1 ❑ Anent, ,
Received by doted N e) C atb of Delivery
D. Is delivery address different from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3.Rertifiiied
Ice Type
Mail ❑ Express Mail
egistered ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transferfrom s 7006 0100 0003 9946- 5840
Ps Form 3811, February 2004 Domestic Retum Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
MC 28
4-119��=
• Sender: Please print your name, address and ZIP444n-this box
Georgia 1: Ricks
Post 0 ce Box 4549
Emera%ilsle, N. C. 28594

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT r, .
I hereby certify that I own property adjacent to Gcov�e,1e— L . Lcks 's
1 I ,(Na a o�f,Prope Owner)
property located at 3 �5 NtC�CC lu 1,c:L\ 1 V— l �
(Address, Lot, Block, Road, etc.
on �05VL , in Ehtf604 lSICI (, , 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 fill in description below or attach a site drawing)
Ica--i L++
RECEIVED
MAR 2 0 2013
bCM--MHD 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.
Mailing Address
atZCIo 0 1SIC
CityKA . U. ' 2s5qL1
Telephone Number
[Z5ZI b4(-5101
Date
(Adjacent pperty Owner information)
Print o Type Nine
Mai g Ad
� � tec �l „�sL`e, O�G 171
City/StateMp
Telephone umber
Date
(Revised 6/1WO12)