53020_BROWN, MARY_20081222

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ElCAMA / ' I DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New I-JModification `L]Complete Reissue ❑Partial Reissue 7
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resourc s
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 # O Subdivision
Authorized Agent i 1, f t - ' "l ', City
Affected 4CW ❑;EW ❑ PTA ❑ ES ❑ PTS Phone # ( )
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
ZIP
River Basin, ( ((_
- nat /man /unkn)
Type of Project/ Activity
-
(Scale:
/
Pier (dock) length
Platfo
Finger
Groin
Bulkh
Boat
Othe
Shor
SAV:
Sand
Phot
Waiv
A building permit may be required by:
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
length
number
ead/ Riprap length
avg distance offshore
max distance offshore
Agent o'r Applicant Printed Name
Signature '"Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature �^-------""
Issir g Da epiration Dat
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/ 1-888-4RCOAST
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

v
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE&Mn'
)
"
I hereby certify that I own property adjacent to ,� � 1/
(Name of Property Owner)
/
property located at q 3 d ` Za & h � . d c D , A2co- ,
(Lot, Block, Road, etc.)
on NevJpbf4A1d @T ,in QiLA iP6 ,N.C.
(Waterbody) (Town and/or County)
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 pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of ripar+.., ccess unless
waived by me.
�,Q I do not wish to waive the setback requirement.
&7 �G
G�
I do wish to waive that setback requirement.
--------------------------------------------------------------------------------------!VE
- - -- -`-' ------
�A
DESCRIPTION AND/OR DRAWING OF PROPOSED DEL T:
(To be filled in by individual proposing development)
0.
-----------------------------------------------------
(Applicant Information)
Mailing Address
City/State/Zip
Telephone Number
Date
(Riparian Property Information)
x
Signature
.5,,m,ted -(f. G,gyne�l
Print or Type Name
Telephone Number
0- .- f s--e i�-
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE)
I herebycertify that I own roe adjacent to / �' � ����' v 's
fY property rtY J
/ (Name of Property Owner)
G
property located at /� (� �l,�t a,qolq �/, ,`� 4� /.
j' (Lot, Block, Road, etc.)
on L�%✓ , in Yam,./ o r�--- , N.C.
( aterbody) (Town an/or County)
He has described to me, as shown below, the development he is propo at that location,
and, I have no obj ecti to his proposal. I understand that a pier/mo piling atlift/boathouse
must be set bac minimum distance of fifteen feet (15') from of ripa ?access unless
waived by
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement. "�
Ste-
---------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED D
(To be filled in by individual proposing develop
-t7
2
------------------------------------------------------�-------------------
(Applicant Information)
Mailing Address
City/State/Zip
Telephone Number
Date
Print or Type Name
Telephone Number
Date

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date
Applicant.Name
Mailing Address
MAJ� -V m 620 00
C�d?
I certify that I have authorized (agent) \-0 hJ f l( �r.S � ; 2 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ?p L VJ R ibU c,
at (location) _ f -� D /� I s G CA-'O6 d -Z)(2 , M e wy©le &) L-
This certification is valid thru (date) _ //3o / O
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagernent.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

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