30411D - Page

toCAMA/ ❑DREDGE & FILL N° 3O41 1-J
GENERAL PERMIT Previous permit #
>C New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources t-y r r, O
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ,/ .
1 ``Rules attached.
Applicant Name V) i/Lir cl PG se% Dr Q_ Project Location: County �.�r U AS, 1N I(...it-
Address 1") V. D , ' '-/). ie Street Address/ State Road/ Lot#(s) /l o IA/. \ctc lf"
City 1 /1('. +1ur i State NC ZIP J39V Or iVe
Phone# ( ) - Fax # ( ) / Subdivision^ ,j_
S "Authorized Agent Cc r D 4 ( o Ls- Os r`City ah Ct ZIP
Affected LiCW r EW PTA S - PTS Phone # ( ) River Basin 4(/Ai 6,r
AEC(s): ❑OEA HHF IH :1 BA N/A Adj.Wtr. Body r/ w '' /It% man unkn
❑PWS: FC: [, 1 VVYv t„ /
no ORW: yes / PNA yes /L.� Crit. Hab. yes / no Closest Mal.Wtr. Body �f
Type of Project/Activity C O/o trvt,7 6I v � �jcJ/�C/1<ti� /.h $q„Af Jq /j ►l Pi�v� q S .Q /s�/A✓/)
'-4yi-st (42 bc) J.. d-�4' 1,vsttfrwgr(J affiXIS�ri) WCStTIdc 60 )kAC (Scale: �• )
Pier(dock)length �C``
Platform(s)
Finger pier(s) Z - 1! 7-2______ _ (
Groin length /'ty' ID / !
number_ di ,� f/
Bulkhead/Riprap length bp 4. / i
avg distance offshore- 1
max distance offshore )Q$r/_1 } pie r J-f
Basin,channel - �h-4.4 - 6,q�Tjf
` -
cubic yards
Boat ramp
Boathouse/Boatlift ^ QT_-�_ �^T
Beach Bulldozing �ro off V ) k R{4 ck \ r
Other , `f/ EvSlin9
, ,._ _ , 0, _......„..._...H.____ .
> 1--;;
Shoreline Length 150 P' S` „
�� pp tJ'
SAV: not sure yes lam' !3 ' 11c — tus P
Sandbags. not sure yes ( l • 0.
Moratorium: n/a yes no � � � �«�Cti�E � �I ~'�
ct -kr('z' r�� i� 1 1.--; t./
Photos: yes no P �+0// C�
Waiver Attached: yes n —_-- _-.- --_--- ...-. ! L_-- r ('
A building permit may be required by: IC'W/1 D ( (/G k _C 40 A d F.See note on back regarding River Basin rules.
Notes/Special Conditions + ' /' Cc)/) ti f 4.#O/1( 6 1211• r //O`z SAk/ G///y ,
' nfu0 ('' � ! e. f #�> 0 . `� A,
Agent or plicant Printed Name 4 l Permit Offi is Si re
__ '(/f w 0
SiiIsature '�"�'Please read compliance statement on back of permit**
suing Dat Expiration Date
���- ° It!16.5 ��Gs�,, cJ QOS° Z / 9 iii
Application Fee(s) Check# 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 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(9 I 0-395-3900)for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District Washington District
Mailing Address: 1367 U.S. 17 South 943 Washington Square Mall
1638 Mail Service Center Elizabeth City, NC 27909 Washington, NC 27889
Raleigh, NC 27699-1638 252-264-3901 252-946-6481
Location: Fax: [phone] Fax: [phone]
(Serves: Camden,Chowan,Currituck, (Serves: Beaufort,Bertie,Hertford, Hyde,
Parker Lincoln Building
Dare,Gates, Pasquotank and Perquimans Tyrrell and Washington Counties)
2728 Capital Blvd. Counties)
Raleigh, NC 27604
9 19 733 2293 / I-888 4RCOAST Morehead City District Wilmington District
Fax: [phone] 15 I-B Hwy. 24 127 Cardinal Drive Ext.
Hestron Plaza II Wilmington, NC 28405-3845
Morehead City, NC 28557 910-395-3900
202-808-2808 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Carteret,Craven,Onslow-above Onslow-below New River Inlet-and
New River Inlet-and Pamlico Counties) Pender Counties)
Revised 10/C

• GENERAL PERMIT - COMPUTER FORM •
FIELD REP: . APP FEE:
•
PERMIT NO: - COUNTY:
AEC DESIG: • t_c WATER BODY:
APPLICANT NAME: ud u l i k r-c P i-e J ' •
ADDITIONAL NAME(S) : - • ,
MAILING ADDRESS: • • PHONE:
--. CITY: • STATE: • • ZIP:
PROJECT LOCATION:
INCLUDING CITY OR LOCALITY n (WHEN DIFFERENT .FROM MAILING ADDRESS)
•
DEV AREA: _ . ) OPROJECT DESC:r - / / LAT (X) : • LONG (Y)
WORK: (6 H - - 6°. .
CODE LENGTH WIDTH DEPTH CODE LENGTH . WIDTH DEPTH
-MNT: (- — t, • _) L — — - _)
CODE LENGTH WIDTH DEPTH CODE LENGTH WIDTH DEPTH -
IMP: (SB SQUARE FEET (D) ( ) ` )
CODE Q CODE SQUARE FEET CODE SQUARE FEET
ACTION EXPIRATION
DREDGE AND FILL REQUIRED:
CAMA MAJOR DEVELOPMENT REQUIRED:
*****************************************************************************
•• •- CODES FOR AEC DESIGNATIONS -
-
"OH" — Ocean Hazard - ' "CW" — •Coastal Wetlands -
"EW" - Estuarine Waters "FC" Fragile Coastal Natural/Cultural
•
"ES" Estuarine Shoreline T "PW" — Public Water Supply
"PT" — Public Trust : • • •-• -" ."OR" .— Outstanding Resource' Water -
- - - " . - • . CODES FOR .PROJECT ; •
"P" Private, usually. an individual -' - "F" Federal • • .
"C" Commercial-" V - •'. "L" Local Government
"U" Utility _ : 1 "H" Housing Development
"S" State- -• - ; . _-• :"O" Other - - --
•
•
- - ; - - ' . - � • CODES FOR DESCRIPTION .• "" • . � -
•"11" Bulkheads,. Riprap - -••-- •= - "16" Utility .Lines
"12" 'Piers, Docks, Boathouses :* . . . - - '"17" Emergency Repairs .
"13" Boat Ramps • - = "18" Beach Bulldozing "
"14" Wooden Groins - - • "19" Temporary Structures
"15" Maintenance of Basins, Channels, Ditches - _ V .

' TABLE 2-COnf:S FOR NEW IYOR)c on MAINTENANCE
f Dimcnsinec In fret or square Ird uulrss^ihrnrisc slalcd.l TABLE 1-COI)E•_S FOR n(:SCRIII'ION OF DISTURBED AREAS
f I)Imcnsiens hi uluarc Irrl unlr:cs M1lmrkr nmrdl
CODE TYPE OF DEVELOPMENT DESCRIPTION l
/` EXAMPLE . I
•
MAJOR SPECIFIC
"AC" Access chenndl,canal length, width, depth "AC200,20,-4" GROUP IMPACT DESCRIPTION EXAMPLE
. "AR" Artificial reef length, width "AR200,50"
"AS" Artificial 'seaweed length, width "ASS00,100"
"BA" Beach or est. access ' -- "BA" "WS" * Wooded swamp "WS450" I
"BB" Boat basin, slip length, width, depth "BB1S0,50,-6" "CY" Cypress "CY150"
"DH" Bulkhead length "DH150" "GU" Gum • • "GU150" I
•
"DL" Boat lift length, width. "BL25,15" • "CE" Cedar "CE150"
"BN" Beach nourishment length, width "BN150o,50", ' "SM" _ Maple "SH150"
• "DP" Boat ramp length, Width "HP100,10" ' "PO" * Pocosin "P0250" '
' . '"BR" Bridge length, width "BR75,50" "MF" * Maritime forest "MF175"
"BS" Boat house length, width • "BS40,20" "HM" * High marsh "N11390" '
"BW" Breakwater length "Hwlso" "JR" • Juncus roemerianus • "JR30"
. "CC" Cable crossing • length "CC275" (black needlerush)
1 "CE" Condo expansion i units new,existing "CE45,40" • "SY" Spartina cynosuroides "SY60"
• "CG" Campground length, width "CG175,400" (salt or giant reed grass) 1
"CO" Condo i units, height "C064,45" "SP" Spartina patens , "SP35" •
"CV" ' Culvert length, width "CV60,15" (salt meadow grass)
"DD" Drainage ditch length, width, depth "DD900,12,-8" "DS" • Distichlis spiceta "DS50"
"DO" Dolphin ' number "D04" • (salt or spike grass)
"DS" Drystack storage length, width, height "DS200,75,50" "SS" Salicornia sp. "SS38" .
"EL" Pier "L" head length, width "EL10,20" (glasswort)
"FB" Fill basin,'slip length, width, depth "FB300,50,-4" "LS" Limonium sp. "LS40"
• "FC" Fill canal, channel • length, width, depth "FC300,50,-4" (sea lavender) •
"FH" Fish house length,.width "FH150,75" • "SC" Scirpus sp. "SC20" '
"FI" Fill, general ' length, width, depth "FI300,50,-3" (bullrush or three square)
"FR" Fill for road length, width, depth "FR975,50,-2" "CJ" Cladium damaicense • "CJ27"
"FS" Floating structure length, width (use this only when (saw grass)
no other code fits), "SA" Spartina alternaflora "SA75"
. - "GR" Groin length, width "GR200,2", (salt marsh cordgrass)
"HO" Hotel, motel complex length, width height "H0450,75,50" "TY" Typha sp. "TY32"
Nine. Highway, street length, width "Hw1000.50" (cattail)
"JE" . Jetty d length, width "JE30,2" "BF" Borrichia frutescens "BF42"
"HA" Marina a of slips ^mas0" (e::•a oxeye)
"HE" Marina expansion i slips new, existing "t1E15,20" "IF" • Iva frutescens "IF76"
"HI" Mitigation length, width "MI50,25" (ma: th elder)
"MR" Mooring piling number "MR5" "PH" Phragmr:ea sp. "PH60"
"NP" Non-pier 1ereth, width (use this t.n:y when , v " "LBW
no other code fits) *..1' * 1.04 cre•, LM50
"OP" Outfall pipe diameter in ", length "oP6,2000"
NOTE, This is not a sewer line extension unless it results "SA" Spartina alternaflora "SA30"
in a discharge to state waters. For example, a WWTP - (salt marsh cord grass)
effluent pipe would be "OP" '
"0T" Other --- "OT" "HG" * High Ground "110750"
�.► (includes spoil disposal)
"PC" Pipeline crossing diameter in ", length "PC8,450" "OW" * Open Water (Use with piers. "OW900"
"PI." Parking lot . length, width "PL180.50" • mooring pilings etc. whirs
"PM" Pent mining acres "PM50" there is little bottom
"PR" Pier or dock length, width "PR160,5"
"RR" Riprap length, width "RR150,5" • disturbance.) ,
"SC" Cable, pipe crossing **no longer used** eSBe * Sha]low Water Bothom
i lots, total acres "SD42,50" (Used for bulkhq ads,, "58550"
"SD" Subdivision
"SE" Subdivision expansion i lots new, existing "5E20,50" excavation etc, where
"TE" Pier T head • length, width "TE20,6^ there is a mayor alter-
^
ation to the bottom.) I
•
• "BC" * Beach "BC150"
. , i
' "DN" * Dune ^DN200"
q
"GB" * Submerged grassbeds "GB75"
"WL" * COE designated wetlands ".404 75"
• (Use when other species r
are present. not list- •
ed elsewhere).

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
`"ct/Khe.a.d
Name of Individual Applying For Permit: Y,(/).,,b a q y�
Address Of Property: ///5 2 /i). ± �� r A )0A
Di=a,c
(Lot or eet #, Street or Road, City & 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 have no objections to this proposal.
If you have objections to what is being proposed , please write the
Divisions of Coastal Management, 127 Cardinal Drive Extension,
Wilmington, North Carolina, 28405, or call 910 395-3900 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 , lift or sandbags must beset 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.
•
S:.. ;�:: %• • Date •
Pr ..:::«e Lfs s7 Dm, / ��rc
9i0. 27B, Soli 1's �o E N N F=I
Telephone Number With Area Code

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
/ea lKhNaci
Name of Individual Applying For Permit: n
APP Y� g �iC,J.(.��Ct/Ltk � �Q G�i/;41
Address Of Property: /l/, ,,z LLL.paf 9-Qrj f JCL
Dot r / JL , fi , (Lc C
(Lot or Meet #, Street or Road, City & 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 have no objections to this proposal .
If you have objections to what is being proposed , please write the
Divisions of Coastal Management, 127 Cardinal Drive Extension,
Wilmington, North Carolina, 28405, or call 910 395-3900 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 , lift or sandbags 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.
/ I
Signature , / • Date
;�i44/ /7 - ) i C ,E� 1
Print Name `
ED I --I N FO
Telephone Number With Area Code

CARSON LJACOBS 1165
NCDL 367729 PH.910-842-6978
1200 STANBURY RD SW (y—0 66-112I53I
SUPPLY, NC 28462 Gale 62101
62101
AY' QAM I $ /00. oJ
dry,a,,,y-
V 1(0-. (a-a col
BB&T ACCESS
BANKING
BRANCH BANKING AND TRUST COMPANY
Sp PLY,NORTHzylp‘
1' Q�'�►t 13OCUlynabire
I:053LOLL2Lt: 5L956452L5u' LL