31590_VENTERS, KIM_20020402

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GENERAL PERMIT
Previous permit #
_INew _: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 area of environmental
concern pursuant to 15A NCAC
Rules attached.
Applicant Name
Project Location:
County__
Address
Street Address/ State Road/ Lot #(s)
City - State ZIP
Phone # O Fax # O
Subdivision
Authorized Agent
City
ZIP --
Affected Ll CW DEW ❑ PTA ❑ ES ❑ PTS
Phone # (_ _)
River Basin
AEC(s): ❑ oEA ❑ HHF ❑ IH ❑ UBA [I N/A
Adj. Wtr. Body
_ N % It.
t gnat /man /unkn)
❑ PWS: ❑FC:
_
ORW: yes / no PNA yes / mo Crit. Hab.
yes / no Closest Maj. Wtr.
Body —
Type of Project/ Activity
Pier (dock) length_
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
T
avg distance offshore
max distance offshore
Basin, channel _
cubic yards
�-
Boat ramp
i
Boathouse/ Boatlift.
Beach Bulldozing_
Other
Shoreline Length
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 Name/
Signature "Please read compliance statement on back of permit"
(Scale: iJ I- ) I
-i— -
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s)
Check #
Local Planningf urisdiction
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 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 / 1-888ARCOAST
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)
Revised 10/C

OCCUPATIONAL & INDUSTRIAL SAFETY
CONSULTING, INC.
716 LILLIPUT DR. PH. 252-638-3179
NEW BERN, NC 28562
PAY
TO THE
ORDER OF
66-112/531
DATE4aof—z"—
�r--C� / q, /Dv/
01901 BB&T DOLLARS El .,,...
NCM BANKING AND TRUE? CoM,ANT
375ASOUTH FRONT STREET
NEW BERN, NC 28560
FOR!4?%�3� �!`�
— — ----- _— --- — — — -- Nr
II'0000 L 2801I' i:0 5 3 10 11
2 LI: 5 1 1 5600 681I'

ADJACENT RIPARL-�N PROPERTY OWNER STATE-N ENT
(FOR A PIER/MOORING PILINGSIBOATLIFTTBOATHOUSE)
I hereby certify that I own property adjacent to ;/
(Name of Property Owner)
property located at U C wv 5 C CK fC K c f.
(Lot, Block, Road, etc.)
on (Ue' l2 , in_ C - ,� G��� , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the deve'.opment he is proposin at that location,
and. I have no objections to his proposal. I understand that a pier/mooring
piiina3iboatlift/boathouse must be se: back a minimum dis-ance of fifteen feet (115') from my area
of riparian access unless waived by me.
I do not wish to waive- the setback recuirement.
I d-q wish to waive tr.at setback recuirement.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOP`fE'N-T:
(To be filled in by individual proposing development)
ig7,ature
T-e-v�V1ll�ce
Prim or Type Name
Pe!ephone Number
Date: 312c� a Z-

ADJACENT RIPARL-kN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to �/1A
(Name of Property Owner)
property located at 4-7 oy {' Cye°e i,
(Lot, Block, Road, etc.)
on TK('i��� �tv{t , in /I%(.,' V�(k,-) CkAU-C , N.C.
(Waterbody) (Town and/or Coun _ )
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 understar!d that a pier/mooring
pilings/boatlift/boathouse must be se: back a minimum distance of fifteen feet (115') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive tr.at setback re uirement.
DESCRIPTION A.N'D/OR DRAWENG OF PROPOSED DEVELOP`fENT:
(To be filled in by individual proposing development)
Signature
40/'5
Print or Type Name
,�S 2-- � Sy - 2�? '�
Telephone Number
Date: _Y z'� 116 2—

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