54377_D&P DENTALS_20090813

❑ CAMA / ❑ DREDGE & FILL �An (/ /y/� � /1�T�
GENERA. PERMIT {n Previous permit#
❑New nModification ❑Complete Reissue El 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 ,' Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ! ZIP_
Phone # (} Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # (,) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier
Platf
l.
Fing
Groi
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
SAV:
Sand
Mori
Phot
Waiv,
(Scale: )
rm(s)
Authorized development is suspemi
until December 31, 2010, pursuant
the "Permit Extension Act of 11 •
I ...
r pier(s)
length
number
avg distance offshore
max distance offshore
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i Bulldozing
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line Length
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yes
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A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
is
ed
to
Application Fee(s)
Check #
Local Planningf urisdiction
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, certifythat 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/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
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)
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

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PRITCHARD CONSTRUCTION, INC. 33 66-11571531
GENE RALo NT CONDRIVE RACTOR
ASHEBORO, NC 27205 DATE 7 - / 1-y
TO THE s•=•„,Y
ORDER OF
DOLLARS
/1 n 1 t1Ci/ --
Randolph Bank
ASHEBORO. NC 27205 �
i
FOR --
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORI_NG PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to /2fA T41- 5 is
(Name of Property Owner)
property located at D ,owVD n /D i vL
(Lot, Block, Road, etc.)
on pow , in fJ T4-J/vtff J?�7C// , N.C.
(Waterbody) (Town and/or County)
Applicant's phone # Mailing Address:.?,, �ld,�Tiy*e—h-%Aowe
flS/t6 d/Ld , /r/, ?. J-%2D3
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 riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.), ,
I do not wish to waive
+� I do wish to waive that setback requirement. AUG i Z009
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEIM"ibad Uty DCIVt
(To be filled in by individual proposing development)
�FO1,�9C : DA-�-it6co P114-6:
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--V& 1" ©A7,4r4-
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
za& /u1)x�rtt*0xr- P'LiLZ__
Mailing Address
'City/State/Zip
331 3*-- 3�
Telephone Number
Signature Date
(Riparian Property Owner Information)
Signature
Dc> ,v /S R »J O y
Print or Type Nam
C 5,1 e 715 S9
.268, Patin bRtuL ,JS:2- 2 ttd 305-U
Telephone Number
Da

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to n 4 P P-E-014LS is
(Name of Property Ow la
property located at
P6X)D CA11/
(Lot, Block, Road, etc.)
AUG 7 200:,
on IDOxuD ,in Ar/-AWTJL BGlcltl k4GFe ---CityIL���rl�
(Waterbody) (Town and/or County)
Applicant's phone #: 7 3O 3 ifs 3 �- i ( Mailing Address: X 43 6 /Vo Q-r// ,0,v7 dn�yL
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 riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
.-IX, do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
t ORS �n �c •4 Ci4
(Information for Property Owner Applying (Riparian Pro ty Owner Information)
for Permit) I117_
Mailing Address / Signature
Uc2ET% eAnAt-RoN
City/State/Zip Print or Type Name
331,- -3G
Telephone Numbe
® /
Signature Date
i 2, Pons 0 C&I V Z_ )- t-1 I S 3 n
Telephone Number
Date

IF
AUG 7 2009
Morehead City ®CM

AUG 7 Z009
Viofeoead City DCM

op'
NCDENR
North Carolina Department of Environment and Natura
Division of Coastai Management
Beverly Eaves Perdue, Governer James H. Gregson, Director
Date 9 -7-0)
Applicant Name
Mailing Address 2</31G I?IyAr//�zo*jr �Deibl�5
1344e /UV - 2i)-1)3
Resources
Dee Freeman, Secretary
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) 1D2-k
at (location) -2 ilk ehV-,
This certification is valid thru (date) /� - 7- V 9
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper