56927_BAILEY, LELAND_20101029

r ❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification El Complete Reissue ❑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 I SA NCAC
Applicant Name
I
Address w ;,
City
Phone # ()_
Authorized Agent,
Affected El CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ;V.* ZIP ?
Fax # O
❑ EW ❑ PTA ] ES ❑ PTS
❑ HHF ❑ IH G' UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
'CJg t�1
Previous permit #
Date previous permit issued
t 1. " 00o
El Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O ' I River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
M.
.............■®.l....■.....■........../
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit*
Application Fee(s) Check #
�I
N,
Permit Officer's Signature
Issuing Date Expiraiion 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, 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/ 1-888ARCOAST
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

IBC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Leland Bailey
Date: 10/29/10
Permit #: 56927C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Open Water
Dredge O Fill ❑ Both ❑ Other ❑O
169
169
Dredge ❑ Fill O Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised.02/03/10

OCT I
-A MOMIOAMYDCM
North Departrllent of En-vironmu-nt and 1,1134turlal Resources
'w'sioij (of Coastal Manags-went
Michael F. E-asiF.y, Governor halesS. Jones, Director William G. Ross Jr., Secret iry
Date I>
Applicantdame
Mailing A( Idress
I certify that I have authorized (agent) fav5cr—' to act On Ml:
behalf, fol'tbe PurPO-se of g applying for and obtaining all CAMA Permits necessary to
applying 1!)
e-
install or construct (1ctivity) 1�!� CL
at (location)
l thru (date)
This cerbfi cation - is valiA-,c
Slunature
n