51299_EMBARG_20090908

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue El 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
Previous permit #
Date previous permit issued
0 Rules attached.
Applicant Name I- " Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # O
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑FC:
ORW:
yes / no, PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Subdivision
5 1 �99
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat ,/man /unkn)
Closest Maj. Wtr. Body'` ' j
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale:
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
i
i
i
` t
1 I
i
{
I
-
I,
I
Shoreline Length
SAV: not sure yes Cno✓
Sandbags: not sure yes no
Moratorium: n/ayes no
Photos: ye no
Waiver Attached: yes 0 i -- -111, ILL-
A building permit may be required by:
Notes/ Special Conditions
I
I It
❑See note on back regarding River Basin rules.
LIP
Agent or Applicant Printed Na
�✓ i ,C,��F; 1 f� JpifO�', 1
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
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, certifythatthis 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

SP 01 002643 65276 E 14 ASNGLP g
I'll- III' � a -
NC DEPT OF ENVIRONMENT & NATURAL RESOUR
600 COMMERCE—AVE ---. __ - - - —
MOREHEAD CITY NC 28557 S Out 8 Z009
Morehead Cite D
Vonrinrii nnnn07ARV) Vondor-Namp• Nr nFPT nF FNVTRnNMFNT R NATUR
Check Date: 08 / 17 / 2009 Check No. 0015801804
Voucher ID
Invoice Number
PO Number
Invoice Date
Gross Amount
Discount
Paid Amount
XK023459 MA081309 08/13/2009 400.00 0.00 400.00
CAMA PERMIT
Embarq Accounts Payable
Total Gross Amount
Total Discounts
Total Paid Amount
000001/000001
$400.00
$0.0
$400.00
? 's"r O 1T CON f1�IS AN Aft J JAL WATERMARK - HOLD AT, AN ANGLE TO VIEW
Embarq Management Company 0015801804
Paying Agent on Behalf of Itself and Embarq Corporation's Affiliates
-4� P.O. Box 7936
EMBARGL' Shawnee Mission, KS66207 56-382/412
1-866-611-9325
08/17/2009 PAY "' "`.' 400 DOLLARS AND 00 CENTS .... " " ...400.00
PAY TO THE
ORDER
Of
Wells Fargo Bank. N.A.
115 Hospital Onve
Van Wert, OH 45891
NC DEPT OF ENVIRONMENT & NATURAL RESOUR
600 COMMERCE AVE
MOREHEAD CITY NC 28557
VOID IF NOT CASHED WITHIN 180 DAYS
/Authorized Signature
11100 1 580 I a 0 411' 1:01. 1 20 38 2 ►,1: 9 500 19 2a 390

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Label/Receipt Number: 7009 0820 0002 3712 3585
Class: First -Class Mail®
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Status: Delivered
Your item was delivered at 3:29 PM on August 13, 2009 in NEWPORT,
NC 28570.
Detailed Results:
• Delivered, August 13, 2009, 3:29 pm, NEWPORT, NC 28570
• Notice Left, August 12, 2009, 11:31 am, NEWPORT, NC 28570
• Arrival at Unit, August 12, 2009, 9:16 am, NEWPORT, NC 28570
• Acceptance, August 11, 2009, 2:57 pm, MOREHEAD CITY, NC 28557
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Label/Receipt Number: 7009 0820 0002 3712 3561
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Your item was delivered at 10:19 AM on August 12, 2009 in
WASHINGTON, NC 27889.
Detailed Results:
• Delivered, August 12, 2009, 10:19 am, WASHINGTON, NC 27889
• Acceptance, August 11, 2009, 2:56 pm, MOREHEAD CITY, NC 28557
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Label/Receipt Number: 7009 0820 0002 3712 3592
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Your item was delivered at 12:11 PM on August 15, 2009 in NORTH LAS
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Detailed Results:
• Delivered, August 15, 2009, 12:11 pm, NORTH LAS VEGAS, NV 89081
• Acceptance, August 11, 2009, 2:58 pm, MOREHEAD CITY, NC 28557
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Label/Receipt Number: 7009 0820 0002 3712 3080
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Your item was delivered at 4:00 PM on August 18, 2009 in BEAUFORT,
NC 28516.
Detailed Results:
• Delivered, August 18, 2009, 4:00 pm, BEAUFORT, NC 28516
• Notice Left, August 12, 2009, 1:45 pm, BEAUFORT, NC 28516
• Notice Left, August 12, 2009, 1:28 pm, BEAUFORT, NC 28516
• Arrival at Unit, August 12, 2009, 8:02 am, BEAUFORT, NC 28516
• Acceptance, August 11, 2009, 2:58 pm, MOREHEAD CITY, NC 28557
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