47559D - Collins

0 CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification []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 I SA NCAC
[:] Rules attached.
Applicant Name
Address
State ZIP ' . x L4 `-; f;
Phone # ( )
%'
► r Fax # O
Authorized Agent
Affected El CW
DEW
0 PTA ❑ ES ❑ PTS
AEC(s): 0 OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes / no
PNA
yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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
Signature ** Please read compliance statement on back of permit*
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision I i t i l :,
City '_ ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body t'y
(Scale:
i7 See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
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 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, 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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ I-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

CAMA/ Li DREDGE & FILL 4'
iENERAL PERMIT Previous permit# 4S99I
New Modification RComplete Reissue Partial Reissue Date previous permit issued !f1/o
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 71+ /ZC.-
1 Rules attached.
Name _A-WI .1 ,j/{-1V I - ( 2L L-1 l- Project Location: County P(;.1'.JO K
OS R • Ft-"j(.-j t& _V F F DIL . Street Address/State Road/ Lot #(s) ,C, IG
'lyb1 f7sn70 _State M L ZIP 2M1-j-4
(I) ) 2-lb- ;RI(.Fax# ( ) Subdivision FL—LAC A-7,./ r<=L--L"- F
Kd Agent City vyTST�7� ZIP Z 4 L
❑CW ❑EW [ +TA ❑ES ❑PTS Phone # ( ) River Basin C/-y'1�C%
❑oEA H HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body 1/I IZGI N I A- C K e->✓vc.- ( at)/n
❑ PWS: ❑FC:
fes / C:� PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body A I wVV
Project/Activity r"F 1 V lire VI 1N/ I. --k"r a, V(\TL ) i 1 Xr , LA.-Tit_ (—+A .
-?,
(Scale: 1.
k)length 2-24' %y
:s) Ib "t D' Fisccv 15 >Ert'nriz V ii2_ NIA L42-E::tkk— /*`--
sr(s) 1 j , / ram'igth
iber w '4M4 -- ic' i0� 1 1
it,o I yt
I/Riprap length / In \ .
dis an a offshore I ` Fr
` _ '
-- -(distance offshore i '—. -- Imo' t --- � ---- -a--
annel i ,,,tti \7
is yards t I N w
'CV vi
ip ifi
;e/Boatlift 1 _ ! A ith,
JTv v c 1'l -e, rYv
i i 1
illdozing I
I i
,I
NO1 .vkieLACii )NTZ)
y
y
Length i% / 1 + ' l'4 AN y EA Li 1. '
not sure yes no -tin Stvs Lti 1 _
' � � I-�C. �IS u I
-1- j --
c: not sure yes � � ,
um: n/a yes no - --
yes no fr 1- ✓r< �` f(/`'m
attached: yes no I—.—
•
(:.); D' S
ig permit may be required by: 71V...._ I See note on back regarding River Basin ri

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BiMrbARCS OF PRACTICE OR LAM SURYEYINC IN NOR1M CAROLINA.
JONATHAN L. WA RLS 1-3391
COpyrlght 0 Honorer DeSjArn Serv;Ce9, PA,, Ail rights reserved
reproduction or us! of the content* of this document, or additions 711S MAP 15 NOT FOR ACCORDARON
or deletions to this document, In whole or port, without the written 50' 25'carmen! of the fanio eurrayo, is prohibited. .}gyp---- ----�.50'
Only copies from the original *f this document, marked with ar '
a'fglnoi signature anal original seal of the surveyor shall be . SCALE AV FEET
considered to he valid end hire ',Alec _ ¢n

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----- VLLIlnL VI'RI«JL lI`IW f"�iV` �,
DIVISION OF COASTAL MAN G
ADJA_caNT RIPARIAN PROPERTY OWNER,NO I1r1CATIONI FORM
Name of Individual Applying For Permit J N E 14 A� CO L I AF S
Address of Property__ I cE ei4 S B L IF
(Lot or Street#, Street or Road)
NA/ri?TEA D, N• C • (PE1ll DEe Caulk i)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The inndlvi
applying for this permit has described to me as shown on the attached drawirra the development
are proposing. A description or drawing,with dimensions,should be provided with this lette
I have no objections to this proposal. _
If you have objections to what is being proposed, please write the Division of Coe
Management, 127 Cardinal Drive Extension, Wilmington, NC 23405 or rail 910.395-3
within 10 days of receipt of this notice. No response is considered the same as IIo objectic
you have been notified by Certified MaiL
WAIVER SECTION
I understand that a pier,dock,mooring pilbzp,breakwater,boat house or boat lift must b€
bck a minimum distance of 15'from my area of riparian access-unless waived by me. (If:
wish to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15'setback requimnent
•
I do not wish to waive the 15' setback re:q ire-new_
. Siffi Name Date
Prim name
Telephone • AditkaL.AA
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13/2007 09:27 9103291864 PRUDENTIAL CAROLINA PAGE 01/
-13-2007 08:12 From: To:93291864 P.21E
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F Easley,Governor Chance S.Jonas,Director William 3 Ross Jr,Secretor:
Authorized Agent Consent Agreement
Is hereby authorized to act on my behalf
tforirned Name al Agvnq
n order to obtain any CAMA permits) required for the property listed below The authorization le limited to the
pec,fic aetvities described in the attached sketch
.00ATION OF PROJECT:
/05 EAs r L 4 FC DR
PROPERTY OWNER MAILING ADDRESS:
10,5- EAR I n14 804 f:-.F
tf-A,A P r EA D, 1V a?i,L..q3
PHONE NO 9/0 — "' 3P/t
AUTHORIZED AGENT MAILING ADDRESS;
PHONE NO.
— - c � J
Signature of Property Owns•/f�//�J�//�ilk o A e (iQ2,Q
V J rJ
of A A.......�