40304_BELL, ALEX_20041112

CAMA / ❑ DREDGE & FILL
GPENERAL PERMIT Previous permit#
❑New ❑Modification I ]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 area of environmental concern pursuant to 15A NCAC
i7 afftfkules attached.
Applicant Name (`� +" Project Location: County < %
Address --a "O v Street Address/ State Road/ Lot #(s)
City '} State r % < ZIP -- -1
Phone # (`) > %,�y 7 6 Fax # O Subdivision
Authorized Agent 9 tc e('bl /"I ,�A ' City ' C.. i.e.. �N ZIP a
Affected
❑ CW E+EPv E3'PU ❑ ES ❑ PTS Phone # ( ) "- River Basin )V c 4
C1 OEA ❑ HHF ElIH ❑ UBA El N/A
AEC(s): Adj. Wtr. Body (nat �'ma� /unkn)
1 PWS: ❑FC:
Closest Maj. Wtr. Body
ORW: yes / na PNA yes / 6o Crit. Hab. yes / no
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s) _—
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel g
cubic yards
Boat ramp
f
Boathouse/ Boatlift i f
Beach Bulldozing
Other — _
Shoreline Length ,t
%
SAM not sure yes C�
Sandbags: not sure yes no.
Moratorium: n/a yes no.
Photos: yes no�
Waiver Attached: yes) no
a-
A building permit may be required by:
'See note on back regarding River Basin rules.
Notes/ Special Conditions
Agenfor Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOffie Ir'sSi�gnature
1 �
Issuing Date Expiration 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, certifythat 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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)
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.nccoastaimanagement.net
Revised 10/05/01

MEDFORD MARINE CONTRACTORS 09-03 328
ROBERT N HASKINS , SR.
410 CHURCH RD. 252-635-5242
NEW BERN, NC 28560 _ J _ L�
NC DL#-444-033 ss 30/531
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERAV0ORING PILINGSIB OA T,gLIFT/BOA THO USE)
I hereby certify that I own property adjacent to
I
(Name of Properth Owner)
property located at
(Lot, Block, Road, etc.) �i
on %/yfC/�' �'/3 ��C L— , in � �c/ U ���j /tl, �Y '� �U .��v�
N.C.
(Waterbody) (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 pilings'boatlift/boathouse
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 requirement.
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in Gv individual proposing development)
------------------------------------------------------ - - - -,- ------------
------ ---------------------------
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Print or Type Name
252
Telephone Number
Date: )0 ),1 20

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For delivery Information visit our website at www.uspS-cOIMG
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NEWARK NJ 0714
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1=1 Postage
$ $0.37
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Postmark
711-
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(Endorsement Required)
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$4.42
Total Postage & Fees
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UNITED STATES POSTAL SERVICE -PYs- M-a%44ad
Postage -& Fqe.P ai
USP&
Permit N -1 er
\ �9 Pur
• Sender: Please print your nh dross, and ZIP+4'ij6 thisboi-e—
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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 if space permits.
1. Article Addressed to:
,1,f lei 6-RT S1,0'u! ,
1v1-r- k11i 41r 11 : e 7lt3
A. Sig ure
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B. Received by (Printed C.
❑ Agent
❑ Add%
D. Is delivery address different from item 1? to Ye:
if YES, enter delivery address below, ❑ No
3. Service Type
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4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 3110 0002 0563 2344
(Transfer from service label) —
PS Form 3811, February 2004 Domestic Return Receipt 112195-02-M-40