48946_CAP, PETER_20070606

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reiss/]Resources
Date previous permit issued_
As authorized by the State of North Carolina, Department of Environment and N
and the Coastal Resources Commission in an area of environmental concern purs NCAC
L r ❑ Rules attached.
Applicant Name
Project Location: County
Address I 4'
n n 1
Street Address/ State Road/ Lot #(s)
City
Stat4L' ZIP
Phone # O
` Fax # (^)
Subdivision
I �l
Authorized Agent
City ZIP
❑ CW
❑ EW ❑ PTA ❑ ES TS
Phone # ( ) River Basin
Affected
❑ OEA
AEC(s):
❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
(fiat %man /unkn)
El PWS:
❑ FC:
Closest Maj. Wtr. Body
ORW: yes / no
PNA
yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
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
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
0
(Scale: )
.I.
is
1
,t
n See note on back regarding River Basin rules.
,-., !(,.nfi%q t,60")wO
Agent or Applicant Printg
Signature Please read compliance statement on back of permit '
7N
Application Fee(s) Check #
Perm" C9ff er's Signature
�()7
Issui g D, a Expiration Date
, r t'
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/ 1-888-4RCOAST
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

1 ■ 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"if space permits.
1. Article Addressed to:
i n
��A�u�► , ZA s�o z
A.
Agent
B. Received by (Print d Name) / C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
($ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
j 2. Article Number 7005 1820 0004 3423 5327
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES _PyyOyS�T�AL SERVICE
�y
ERVIICE^Y } 511111
• Sender: Please print your name, address, and Z1-P'+4'in this box
113 X
091EA)7-1 L, �J C Z 8 S-4 I

■ 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 if space permits.
1. Article Addressed to:
` r'/�lzDF�GG�/C� �uiZR�LL
Z S StlAi)II DC AV I
�! NYACK, /v y 10ci D
A.
X ❑ Agent
❑ Addressee
B. Received by ( Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes f
If YES, enter delivery address below: ❑ No
3. Service Type
XCertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise l
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7005 1820 0004 3423 5334
(Transfer from service late,
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

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 •
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(FOR A MMOORING PILIl1 G BOATU BOAT$OUM
I herby caiify that I own property adjacent to PC-rm, �ft p s
(Name of Property Owner)
propertylocatedat II —1 ()9CHgn-D Cc'&E/C koAD (grIENTA-L, /iL
(IA Black, Road, etc-)
an clz C IY A-r 9 C i&F-V- , in � �/ c �y c r i N.C.
(VPamrbody) . (Town andlar County
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I do not wish to waive the setback requirement_
I &o wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filed in by bulividual Pmposing development)
pLFAz I -ILL vuT r3o i ioNI INiT/AL f HE T OD A 7"
AEAQ�� �4NA ,�lL f3AC/� /N i h1E ,,A S: �
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signature
Charlotte Peterson
Print or Type Name
Telephone Number
Date:

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INNERBANKS MARINE CONSTRUCTION, INC.
P.O. BOX 190 PH# [phone]
ORIENTAL, NC 28571
PAY DAT E �J }
OR THE � �� N 7
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DER OF
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66-30/531
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1I CITIZEN BANK
www. f'irstciUzens.com
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