55074_AUTRY, GENE_20091231

❑CAMA / ❑ DREDGE & FILL
'°
GENERAL PERMIT � Previous permit #
❑New El Modification ❑Com Complete Reissue El Reissue Date previous permit issued
P P
As authorized by the State of North Carolina, Department of Environment and Natural Resources r--.
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1-
❑ Rules attached. ry
Applicant Name' i` Project Location: County r
Address^ 1 '" Street Address/ State Road/ Lot #(s)
City JOU i K p State ZIP j'? ! t i a 5ft
Phone # (� .)`T Fax # Subdivision
Authorized Agent City ZIP
Affected El El
ElEW ❑ PTA ❑ ES ElPTS Phone # ( ) River Basin
AEC(s): EloEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Bodgnat /man /unkn)
❑ PWS: ❑FC:
"" N Closest Maj. Wtr. Body ('
ORW: yes / no PNA yes / no Crit.Hab. yes / no -
Type of Project/ Activity (i {J
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
!—fT
Bulkhead/ Riprap length %60 x 1 7
avg distance offshore
max distance offshore ;
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length-fJiJ
SAV: not sure yes
no
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
1 t
Agent or Applicant Printed Name
Signature ** PI a read compliance statement on back of pea t *
Application Feels) Check #
(Scale: n 0,i1 )
❑ See note on back regarding River Basin rules.
t S ,
rut 1111LV1111.C1 SitrttdWIC j{)
Issuing Date Expiration Date
111, , L �'� ��e /�
Local Planning urisdiction Rover File Name

I
A
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 consistentwith 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/ I-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

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
.� IA
Applicant Name (--� P n P
Mailing Address
I certify that I have authorized (agent) t( yy\ 'T)w n (S to act on my
0r)('s MCtiri0e LLCf
behalf, for the purpose of applying for and obtaining Ia/t CAMA Permits necessary o
install or construct (activity) 4-,( i�, hL.l (C
at (location)
This certification is valid thru (date) S i
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet www.necoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recyded l 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 6L e 1 1ru 's
(Name of Prope Owner)
property located at
(Lot, Block, Road, etc.)
on C , in 0,,-If Pii��T , 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 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
I06of marine grade wool
6klffimd
.71�IlillUrC
b
Print or Type Name
_ 13/- 33-9-,2-3
Telephone Number
Date: / z �C� — � C'( C/

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to QA's
(Name of Property O ner)
property located at C KU-Y (J
(Lot, Block, Road, etc.)
on 1 C L , in , N.C.
(Waterbody) (Town and/ r 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 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�Lo6' oYY1aa-,rye Grade
3u1� In ec�
----------------------------------------------------------------- j- .----- --------- -- ; - r i -----------------
Signature
rV
Print or Type Name
Telephone Number
Date: c �?

BERNICE AUTRY
GENE AUTRY
5171 DAVIS RD
WIIVSTON SALE NC 271012/17
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