41343_DOHERTY, PATRIC_20050425

C ,CAMA / y DREDGE &FILL
3
GENERAL PERMIT
Previous permi
LNew'l 'uModification -!Complete Reissue _]Partial Reissue
Date previous rmit 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 I SA NCAC
f
Applicant Name ) ' i L 1� `1 e r y l
Project Location:
i] Rules attached.
County
Address N4 s 1 1
Street Address/ State Road/ Lot #(s)
City_ ✓�.; {} 1 tl State ZIP `2—
Phone # ( ) Fax # O
Subdivision
Authorized Agenti�`�
C
tit _ ZIP
Affected -' CW .SEW LC.] A ❑ ES ❑ PTS
Phone # ( __—)
' `� `� "/� River Basin
OEA ❑ HHF ❑ IH ❑ USA El N/A
AEC(s): -
Adj. Wtr. Body
- J
gnat
Oman Junk_n)
Pws: ❑ Fc:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr.
Body
Type of Project/ Activity
c
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
Shoreline Length I %
SAM 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
Agent or Applicant Printed Namef'
Signature Please read compliance statement on back of permit
(Scale:
r—
YS
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
1-1.41
Expiration Date
Rover File Name
Application Fee(s) Check # Local Planningjurisdiction

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
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.nccoastalmanagement.net
Revised 10/05/01

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER /MOORING PILINGS / BOA TLIFT / BOA THOUSE)
I hereby certify that I own property adjacent to, �• , ,4, -%X/ C
(Name of Property Owner)
property located at
on C.
(Waterbody)
I
Z7
Hock, Road, ect.))
inf Gc // N.C.
(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 ish to ive the setba!Zr
ment.
I sh to Cave hat setb k ement.
DESCRIPTION AND / OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individualproposing dcnelopment)
( See the attached drawing )
P
Print or Type Name
--�-Sz - 6 3 7- 2-1fZz
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER / MOORING PILINGS I BOA TLIFT / BOA THO USE)
I hereby certify that I own property adjacent to✓/%W �t? % i 1�� % is
(Name of Property Owner)
property located at y� �i/�l�/�` 47erIxF '//'�/�( Z-
(Lot, Block, Road, ect.)
on 1 F!'l1 ,i11FA,in L=z�� 6�t=rNC.
(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 objectio s to his proposal. I understand that a pier / mooring
pilings / boatlift / boaoio 'se m st be set back a minim 'm stake of fifteen feet (15')
from my area of rip `a acc unless waived by me.
I do not wi t4 w 'vet setback require nt;
IAawish to waive that setback requirement.
DESCRIPTION AND / OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing; development)
IAI-)
/XC-- t r r
( See the attached drawing )
Signature
tale LL; e S. /YMai�es
Print or Type Name
.1s.2 - 433-a 934�
Telephone Number
4- a 3_a_5
Date

- -_ _-_-_--_�--_-------_____ _-__-------- __---
- -- FVP
MEDFORD MARINE CONTRACTORS 0 h CITIZENS 126 9
ROBERT N. HASKINS, SR.
410 CHURCH RD. NEW BERN, NC 28560
252-635-5242 NC DL# 444-033
PAY ONE HUNDRED AND XX / 100 Dollars
TO THE DEN R
ORDER
OF
66-30/531 00001269
DATE AMOUNT
04/2.5/05 *******$100.00
UTH RI ED SIGNATURE
Permit -Doherty
11'00 L 26911' 1:0 S 3 L00 3001:00 L L L 21, 34996I"