40393_BLAINE, IRA_20041207

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GENERAL PERMIT Previous permit # r
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an aM of environmental concern pursuant to I SA NCAC
Cx-! fl'i✓ -]Rules attached.
Applicant Name`' Project Location: County 4
Address �' ` c Street Address/ State Road/ Lot #(s) (`' !
City ' ' ' `' " " State A ZIP
Phone # �� -?mot t, Fax #
Authorized Agent 7 `'"'./ �"
`1 CW C9'EW B *TA ❑ ES ❑ PTS
Affected AEC(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A
Cl PWS: ❑FC:
ORW: yes / no PNA yes %/ no Crit. Hab. yes / no
Type of Project/ Activity
Subdivision
City �710 �� �" ✓ ZIP e, J .
Phone # ( _) _ River Basin
Adj. Wtr. Body �' '� �' at' man unkn
Closest Maj. Wtr. Body —
(Scale: )
Pier (dock) length
Platform(s) } `-"
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel _
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
— #16'
J
N fir. - / _
!I '.ere-
77---,
Shoreline Length Y� ? ' 4 - - _ r
SAM not sure yes nd'—r—
Sandbags: not sure yes no y'
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: ;Yes,, no -- + >•— -
A building permit may be required by: {.� r / �S See note /on back regarding River Basin rules.
U'v .a/2 GII /'P/1/ Co G-�."7k� 41 .,ip/lam o-PA
Notes/ Special Conditions ✓ /
V4 r+i� a'7� �,✓„1c-o .Qy.
Pc+r 0V6-1raj,-,1VJ
Agent or Applicant PrinpeO N
ZVI
Signatur "Please read compliance statement on back of permit"
-Poo- l -2 -2a-
Application Fee(s) Check #
Permit Officer's Signature
/ )� - %--o Y 1. D' %�
Issuing Date ,Expiration Date
av•l �W 1i
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 (910-395-3900) 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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

1
INNERBANKS MARINE CONSTRUCTION, INC.
P.O. BOX 190
ORIENTAL, NC 28571
252-249-1429
1772
l 1 lY 1© ir� 66-30/53I
DATE T/ // 472
TO THE
PAYR,
ORDER OF 1$ I O v r oG
DOLLARS
0FIRST CITIZENS 412
D W First -Citizens Bank & Trust Company
J�A l">u .>tOriental. N.C. 28571 /
www.firsstcitizens.com
FOR 1J���he, \'c r Vy�.T © YG�3rj�� ✓2%� `��. `i✓I /J
ror
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1x%,rAt'4 i turiltuAly rnur K1 Y V MNEK 61AlI MJ-I Nl'
(FOR A PLMWOORING PLLINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to -- - \ K s \-'6 's
(Name of Property Owner)
property located at 7y1 w��,�l,�} z,� Vj j 05QfC.j 4k, L-Ot 4l)'-
(Lot, BIock, Road, etc.) VON
In
(Waterbody) (Town and/oic 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
pilingslboatIir'Ilboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback reqwemenL
I jo, wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP EN'T:
1 (To be filled in by individual proposing development)
T F— 3z
o m
x io•
s x75
o
Signature
Print or Type Name
X
Telephone Number
Date:

tU✓dtiV ,rALV 1 JL%.Wi t[ A1N JrKVMK1 Y V WIShK N1'A1 ;5U:N'1'
(FOR A PMRIMOORMG PLUNGS/BOATLIFTBOA77foUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
05Q,,q Qk, Lot # I
(Lot, BIoc14 Road, etc.)
on , in AeTTA Y VAV(0 , N.C.
(Waterbody) (Town and/or Comity)
He bas described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his Mposal. I understand that a pier/mooring
must be set back a minimum distance of fifty feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback reguirement.
I jo wish to waive that setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP'ViENM
1 (To be filled in by individual proposing development)
6 4-
Print or Type Name
Telephone Number
Date: )� i d