47561D - Childs

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification El Complete Reissue ❑Partial Reissue
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
Applicant Name
Address—," L � = 11 i I t. � /i..
City State ' C. ZIP'
Phone # Fax # O
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ 0EA ❑ HHF ❑ 1H ❑ UBA ❑ N/A
❑ PWS: ❑FQ
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (,) River Basin
Adj. Wtr. Body f >, ._ (nat /man /unkn)
Closest Mal. Wtr. Body
Type of Project/ Activity
r
(Scale:
Pier (dock) length
I r
Platform(s) - - --
Finger pier(s)
Groin length - -- —
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel 1 —t
I
cubic yards
Boat ramp -- --
Boathouse/ Boatlift 1•:
T--i
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no ,r z}
Sandbags: not sure yes no I
Moratorium: n/a yes no j
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: See note on back regarding River Basin rules.
Notes/ Special Conditions
A. Ile
,agent or Applicant Printed Namgv � r
Permit Officer's Signature
Signature • Please read compliance statement on back of permit **
Application Fee(s) Check #
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
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

•
ICAMA/ ❑DREDGE & FILL 4
;ENERAL PERMIT 1/ Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concernpursuant to I5A NCAC �'"� I I c)t)
�E'Rules attached.
:Name fl'147Z4.1 (Alt-K)-S Project Location: County t-/C t A./Si.tJ 1 G!l
I t2 C1 s J . 14 T LAivT1 C. PI _ Street Address/State Road/Lot#(s)
/V Till'riz'-i- State NC ZIP 20.ib I 7o7 ((NSWiC1 ('r .
(1 i 0 c 7-536LFax#( ) Subdivision
ed Agent SNC'e614N E Vj'11}-erNE- -.S'l1V1: S1 City I1I(rill-it ie r ZIP 2E Li&
❑CW Q EW 1JPTA fES ❑PTS Phone# ( ) River Basin CIS%
❑OEA ❑HHF ❑IH ❑USA ❑N/A
Adj.Wtr. Body yn(117" 611 i 1 N e/r
❑PWS: ❑FC:
yes /fii°_ yro PNA yes / ; Crit.Hab. yes / no Closest Maj.Wtr. Body it/ w14)
Project/Activity Pk I v/--t E , . [, / , 1' (11--IC r fL-- o fru.Lit l I tom)
(Scale: / s(
:k)length
(s) _
er(s)
�--I
igth — } I , i
nber Y ; ;
I/Riprap length Irc I i i i✓As )0 [ I 1
distance offshore
Z' t- ' ,
x distance offshore __ _1- �_
0 f" I ' 1 +cannel N� �� � ' � i —
,Ic yards r
se/Boatlift t 1D� �
°�-F till ,
n
1 /'
illdozing I PAp41.. 1
19(/ i--"-":1
.Length /et
not sure yes lits? 4-7 f) tks k9 W K-r S3 ,
not sure yes
urn: n/a yes no,�
Yes o —i —
atached: yes r _. I ' _i__!
ig permit may be required by: SO l-1-17'2(I(17- [ I See note on back regarding River Basin rn

AFPFA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F.Easley,Governor Charles S.Jones,Director William G.Ross Jr.,Secret
Authorized Agent Consent Agreement
S�fi�o,Q��,JE /494:A/E 6iis'7lueso^/ iC herillay.authorized to act on my behalf
(Printed Name of Agent)
in order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
specific activities described in the attached sketch.
LOCATION OF PROJECT:
aRe4 ti sty r C.,C g 7-7
e.)u-��lPe2.T, NG 8-14
ek i
PROPERTY OWNER MAILING ADDRESS:
/4/9,e y e/>/.=L21 5,
.<f%z�i`�Po,ei /✓c._ 02 8t/!o/ PHONE NO. 9/D-'`4 '7- Soli Z
AUTHORIZED AGENT MAILING ADDRESS:
J A4 jfi✓E M,9 r,VE eOA6T2cie-7:5-ea.4/
33L debAe Pd.
�ouTis/Po,e7i✓c a 8l/G/
14i9,e,N 57-Exo,9,e7 PHONE NO. 949-a 79-30..
Signature of Property Owner. / t'l 71-4 01�S/)
Signature of Authorized Agent: '7 '/aA--/e
Date: #`/9 7
127 Cardinal Drive Ext..Wilminaton.North Carolina 28405-3845

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 9e� G��sLbs
Address of Property: /' 7 &ea^)SCL:xe'<' .5T.
(Lot or Street#, Street or Road)
oi.TlPo,e'i-'AIC 2 8 4-lee/ 8.ea 6oze
(City and County)
I hereby certify 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 with this letter.
i ' I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must be set
bck 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.
C� y-/9-e 7
Sian►Name Date
Print Name An;
9/o-5/e5-4/y8a ��.��

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: Wfi,e y C .rI 2
Address of Property: y6 7 8ku,,)5 soa c.,C Sr
(Lot or Street#, Street or Road)
w77-/P/)F>, A/C a S di6/ &.eu.as,w-c_,<'
(City and County)
I hereby certify 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 descri tion or drawing,with dimensions, should be provided with this letter.
l' I have no objections to this proposal.
P P
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail. .
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must be set
bck 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.)
//U'�4 I do wish to waive the 15' setback requirement.
Q
I do not wish to waive the 15' setback requirement.
/ ___ -i-'Li G- '7
Sign Name Date
Print Name ©r
f/o �/s7=s®_si 1.1ental.ID

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