47481D - West

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
flNew ❑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 15A NCAC
r ❑ Rules attached.
Applicant Name ) Project Location: County
Address ? Z - Street Address/ State Road/ Lot #(s)
City ;,./ , ,-, _ ,j = State ZIP
Phone # ( ) Fax # ( ) Subdivision
Authorized Agent City ZIP
Q.4. �) C
Affected ElCW ❑ EW ❑ PTA ❑ ES ❑ PTs Phone # ( ) River Basin
AEC(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A Adj. Wtr. Body 7 �� nat ma unkn
❑ PWS: El FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body E - `J
Type of Project/ Activity
Pier (dock) length
Platform(s) i r
Finger pier(s) �'G1
Groin length
number
Bulkhead/ Riprap length n {
avg distance offshore
max distance offshore Y
Basin, channel
cubic yards
Boat ramp ` - �• jL>
Boathouse/ Boatlift,) I /- ` 1 2—
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes
no 1
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 ** Prease read compliance statement on back of permit
a
Application Fee(s) Check#
(Scale:
i
io)
❑ See note on back regarding River Basin rules.
I
Permit Officer's Signature I
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
❑ See note on back regarding River Basin rules.
I
Permit Officer's Signature I
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 �_ _1 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
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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 06/29/05

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❑CAMA/ -DREDGE & FILL
GENERAL PERMIT Previous permit#
New Modification Complete Reissue ❑Partial Reissue Date previous permit issued
arized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC)I3. 1 Z , ) o 'f 1 I 0
Rules attached.
nt Name 0 O(2,L.0c-D o W/C51- Project Location: County 07JSC.� >.-•..)
s 2-1 ©S m`.(2•`�-'c-1. 5f Street Address/State Road/Lot#(s)
llLm S v (s-r J State tJ (.... ZIP 2 P?) ----IC 1 ---) T"k 5I
PIE( ) Fax#fm) ) Subdivision0L-'> Sj_.—1"L-C125 V„�/\�
zed Agent \A iD v..)3 yt__ City (-4 2; - C-3- -,/ ZIP - `-
❑CW i>1EW 'E/PTA 3ZfeES ❑PTS Phone# ( ) River Basin \ito
❑OEA ❑HHF ❑IH ❑UBA ❑N/A {9' AI
Adj.Wtr. Body o"r'. l. (nat(
❑ PWS: ❑FC: �y
yes " no PNA yes Crit.Hab. yes / no Closest Maj.Wtr. Body T�1 v
if Project/Activity 11 51- L L. N E-v' 13 ,i R \ _N,/z) P 9._.i.,Q►-' E . 'd,.\L d—
L G i\i NI r' i-►,._-r C II a 5! 0.- Ni.---i, \ I ,
(Scale: i
ock)length
m(s) I Lx 1,b+ _ - ...._..... i -,- -
pier(s) I -
I
ength ` i `` ikPiAt r L I
umber i
acjl Riprap length L ' — {
ig distance offshore 1
iax distance offshore , . ... _—. t..____ 1......_: ..._-_:---
:hannel 1:J 1+Al
ibic yards 2 - i �_...._• }_
m 1 Zn 7�
I -fir-
-
P ,f "'
u oath 12Y.1'� \' � :
-"r:. . j 2' t
3ulldozing /<f - r f I l
41
+ y t �v ��
• 1 e -- L •--- Y -J
le Length 17S not sure yes I _ I
, 1 I
;
gs: not sure yes �....... �_. — ---...
hum: n/a yes ' , 1 1 L. �. ` .._...
yes
1
Attached: yes eno-1 i 1 — --

I, c .3cY give authorization to
An inori Marine Construction to act as the
contracting agent in obtaining and signing for the
requested CAMA permit.
Job site address is:
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My permanent address is:
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: CxI. .)PA fos 111C.
Address of Property: t- S+,
(Lot or Street#, Street or Road)
S0c Ct N(, (a8 5
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indiv.
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lett(
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co,
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-7 7qC
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu:
set bck a minimum distance of 15' from my area of riparian access-unless waived by me
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
XI do not wish to waive the 15' setback requirement.
�-�-� /-//-07
i Name Date
. . AwwWA