54368_FIELDS, BECKY & BELOVICZ, GRETCHEN_20090813

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue 6i
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
Applicant Name_
Address , j1� :� C
City ;��P ryrg `ia s , State , `J C ZIP UL j
Phone # O Fax # (, )
Authorized Agent
Affected ❑ CW l] EW ❑ PTA ❑ ES [IPTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS: _ ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
' C
Previous permit #
Date previous permit issued
I] Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City �t #ECG j ZIP `;
Phone # (;, K' ) Y0— GaI ,S River Basin ,'vk
Adj. Wtr. Bod(nat /man /unkn)
Closest Maj. Wtr. Body
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tlgent Applicant Printed IaMe
Signature"Please rea&compliance statement on back of permit"
Application Fee(s) ICheck #
Permit Officer's Sign ture
Issuing I 5a_tJ Expiration Date
ct;s
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 [)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 howto complywith 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

y
e )• Rr NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James N. Gregson, Director Dee Freeman, Secretary
Date g/10 /o l
AUG 1 1 2009
Applicaut Name V, `X
Mailing Address 5' tM®IrBhead City DGM
I certify that I have authorized (agent) -boVb 4 '�S'to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity)
at (location) 5\k W44
This certification is valid thru (date) jo/ /Zobq_
Signature
)--
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www,nccoastalmanagement.net
An Equal Opportunity i Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
`,JIZLZ
I hereby certify that I own property adjacent to 'd6t-, ,v lv:a /C�Y����.e�. s
(Nabae of Property Ow-w
ner) ,
property located at StV �e c,r C •r ��� �Y;�� �"`
(Lot, Block, Road, etc.)
AUG 1 1 2000
on n �a a�C�•r �� , N.C.
(Waterbody) (Town and/or County ®rel7p ►(I City
Y 0CM
Applicant's phone #:2.S2 393-33-1-1 Mailing Address:�--
C see C✓ z eti �� N c Z$ 5 g y
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:
IT
be filled in by individual proposing development)
p�k:g
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------------------------------------- 1
(Information for Property Owner Applying (Ripa 'an Property ne formation)
for Permit)
Mailing Address
City/ tate/ Zip
'eSI- 3921, — 33
Telephone Number
Signature Date
Signature
Print or Type Name
l Telephone Number
Date

1 .1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORINGPILINGSIBOATLIFTBOATHOUSE)
�e\,-4 ; rz
I hereby certify that I own property adjacent V:,A s / 's
(Na e of Property Owner)` �%
property located at S\\ �Y AEI", 1 Z009
(Lot, Block, Road, etc.)
on ��CY C `r��� In �� Cw��� �Or® N.C.
Vf�� ��;
(Waterbody) (Town and/or County)
Applicant's phone #: ZSI Y13— Mailing Address: Stx Z)�`rY
C' L7. Q O c� y
O y
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 propos ing development)
WAY`=`�
r
4!�— 2 5 0
J-fo�l5r
�oh LV A pit �q f *I -
(Information for Property Owner Applying
for Permit)
Mailing Address
(ir& -,. N (—' 7- S S O L4
City/State/Zip
2S2 393 - 331-1
Telephone Number
Signature Date
J,.,4 �- � ,
F�eet
--- 4--a-
(Riparian Property Owner Information)
��w7z — - -
Signature
Print or Type Name
Telephone Number
Date

BOBBY J BRIGHT 1592
[phone]
228 OCEAN SPRAY DR
( net 34 66-30/
CEDAR POINT, NC 28584 l(C�r 11 342
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