42442_PEDERSON, BILL_20050816

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GENERAL PERMIT r ious permit #
[-]New JModification LiComplete Reissue ❑Partial Reissue ate 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 15A NCA
❑Rules attached.
Applicant Name 1� �^�� Project Location: County =
Address !j' 1� 1'c- i' Street Address/ State Road/ Lot #(s)
City L e-y ; Statep I f, - zlpb�
Phone # (-7 G U 'lax # (i) Subdivision
Authorized Agent City._ zip
Affected Fi CW CHEW Q'PTA El PTS Phone # ( _) River Basin
AEC s : !- OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Ad). Wtr. Body` nt /man unkna
❑ PWS: El FC: )
Closest Maj. Wtr. Body 'll/C
ORW: yes / no,) PNA yes, / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)_
Finger pier(s) k
Groin length —
number —�—
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes
nod
Sandbags: not sure yes
no
Moratorium: n/a yes
`nn
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
(Scale:
See note on back regarding River Basin rules.
>-
Permit Officer' "'Signature
Issuing Date Expiration Date
Application Fee(s)
Check # Local PlanningJurisdiction
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:
[_J 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing ,Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax:[phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
zax
P,0. C-�-)tc 15v
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front M space permits.
1. Article Addressed to:
SToev) U w ic.,iac q
U"tTcnM C I VIC . Q s 3 t �.
A.
X
❑ Agent
B. �ecelved by ( Printed Name) Date of Delivery
D. Is delivery address different f m item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
NCertified Mail ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
0 Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 2260 0002 2063 7802
(transfer from service labs!)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-WI540

111"Jnc,=v 1 rci.rAMLaN rtcv '',1KI X u1NL' LK b I'AIMLLNT
(FOR A PiER/blDORf1VG P /GS/BOAHfFT1H0ATHOUSE)
F
c1d
I hereby certify that I own property &40 10it to Cjj- l ( PC--C)eCX= n _ 's
(Name of Property Owner)
property located at Lc,-, .11 ►_ ��tz i :� 5 x b, �
s
(Lot, Block, Road, etc.)
on , in N.C.
(Waterbody) I (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
pbiings/boaffiUboathouse must be set back a minimum distance of fifteen fit (15') from my area
of riparian access unless waived by me.
,/Z I do not wish to waive the setback requirement
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEIAPNIEN'T:
(To be , Wed in by individual proposing development)
Signature
Print or Type Name
Telephone Number
Date: P - 3 - o -s-
A' i

NNERSANKS
MARINE `
P.O. eox 190 PCONSTRUCTION, INC,
ORIEN7Al, 52-249-142.9
PAY NC 28571
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