Sammartino, Mark

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
-New 'Modification 1 'Complete Reissue 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 15A NCAC
;]Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) — Fax # ( __-) 97
n
Authorized Agent —
Affected J CW 1_-1 EW PTA ES PTS Phone # ( River Basin
OEA ❑ HHF IH UBA N/A
AEC(s): - Adj. Wtr. Body _ _ _ _ gnat__ /man unkn
F--J PWS: --]FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body - -
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s) -
Finger pier(s)_
Groin length --
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel ✓ _--.-
� I
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing J
_ L
�_Other T !� �' _ +
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
See note on back regarding River Basin rules.
Permit Officer's
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date
Local Planning jurisdiction
Expiration Date
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 I) 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 ❑ 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/ 1-888-4RCOAST
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
Date q 1 9, j '2— 0 ) T
Name of Property Owner Applying for Permit:
Mailing Address:
k'\Ae rr I W10-- \ 1\j G
I certify that I have authorized (agent) O� La�a N" NY 1 q to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Uh-G- -aU r"i, bre-a �-0a+
at (my property located at) 3 �,'Gt r %cc CD-n 1 M&n
This certification is valid thru (date) o P � a ► a� 1
Property Owner Signature Date

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Apr 1814 09:19a Golden Plumbing & Heating 703-257-4378 p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PIL.INGSIBOATLIFTIBOATHOUSE)
I hereby certify that I awn property adjacent to Y► A&K I
(\lame of Property Owner)
vinfcrL.,.v ht 3+�-(
property located at L.21T ' 7 ' i 13 G Att-sAc.�r-4 2e� . -mac .s zr ZP SJ (. -(-` 4
(Lot, Block, Road, etc.)
on ri�.�se 2.4,s_ Ccrtv�cL ept' gEaN- .n.T Cr Tee : , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ZS1---Te'4-2-L41- 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. I understand that a picrlmooring pilings; boatlift l boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
Y- I do wish to waive that setback requirement.
--- ------------------- —------------ ------ --- --- — —
DkSCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(To be felled in by individual proposing development)
6 i C-ff.,' x . 13 C' L,,..cw� JS'�
'o'—a ..k,,
(Information for Property Owner Applying
for Permit)
1 13 Ge - 6r-::,..- Of
Availing Address
�ec�...t;...�- pie Z�� Iv •t,��-%
CiiyisiaLw'zip
(Riparian Property Owner Information)
SipatUre
Print Of Type: Nawcz
zzA S�rC G clG 2-
Telephone Number Telephone Number
T'
s i�riWE LIi'; Mkt Date

ADJACENT RIPARIAN; PROPERTY -OWNER- STATEMENT
(I{(IR -Ii I'IL 10i !OORING1'ILINGSIBOA.TLI YYBOATI[O..USLs)
1 hereby ccrtify that T• own property adjacent to
(Maine of Property Owner)
property kwated at L o5f 1Llerri / 3 rG� cow. fir:
` 1 /(Lot, Block, Road(etc.) .
(waterbody) en (To)vu and/or County))
ripplicarit's phone e: J" faa Ma111n Address:.
He. has described to r' c,.as shown below, the development he is proposing at that location, anii; t
li the iio objectiotis.(o his proposal. Z uriderstand that apier/mooring pilings / boatliftIboatliotise
must be set back'a minimum distance of fifteen fret (15') from niy area of riparian access ithless'
waived by me. (If you wish to waive the setbaelt, you [nest Initial the appropriate blank'. .
belolv)
1 do .ndt wish; to waive.: -
. Ldo.wish to:waive tliat.setback requirem0it
- ----- - --- rr rr..--- ------------ ..
r D1✓SCIt1I'`1'JQN ANfI/OIt I)Itrt1Y1N..G OT PROPOSED DEVELOPMENT: ,
'. . (TYo be f711CiL f» G�} indirfdirnl proposiir�'rlsselop»ierzt) •
o ro�� sG� �� � tii1 i off l0 l�;
3© Z_r
::(Infarri�ation foi' Prop r!-y Oiyner Applj,ing.. ([2ipat'1an Piop.ert31 Owner Information) .
for, Permit) ,'. ,.:::.. .
Mailing Address Si�,nature
Cit}+i$faitrLip I ririt u `l'ype;lanle
Tc lcl tone Twin ^r --� _ - �Telephone Nunibei
Sipliature Bate Date. `