40942_HEATH, DONALD_20050217

_ICAMA / II DREDGE & FILL
'
GENERAL PERMIT
Previous permit#
C'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 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 # ( ) Fax # ( )
Subdivision
Authorized Agent
City ZIP
Affected E5CW -1 EW - PTA ❑ ES ❑ PTS
Phone # (_) _ River Basin
AEC(s): ❑ OEA 1 HHF C IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ PWS: -FC:
ORW: yes / no PNA yes / no 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
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
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
Application Fee(s) Check #
(Scale:
H'rSee note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name
)I

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:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
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)
www.nccoastalmanagement.net
Revised 10/05/01

_cn_t y_ nhn n_
INNERBANKS MARINE CONSTRUCTION, INC. 1817
P.O. BOX 190 PH. 252-249-1429
ORIENTAL, NC 28571
D� 66-30/531472DATE 117
PAY A'
TO THE
ORDER OF. t � 100,00
ORDER
s DOLLARS �pM.
nRS"T CITIZENS 472
$AN K F,,=,-Cllliens Bank V T-1 Compa ry
Oriental, N.C. 28571
www.firstcitizens.co
FOR°���
11800 L8 L 7ill I:0 S 3 L00 30011:004 7 L 20 L 28 2 20

nu�ti�.r�t�l tu�r�+tc�wty rKVY�K1 Y VWPlLK S1'Al'�IV'1'
(FOR A PIER/MOORING PHJNGSIBOATIJFTIBOATBODSE)
I hereby certify that I own property adjacent to C�bp a Q 's
(Name of Property Owner)
property located at -U-.s h -T-rt t H 1-41 i ,
(L,ot, Black, Road, etc.)
on C.0-e-ceY. _ , in con,��y G . , N.C.
(VPaterbody) (Town and/oi County)
He has to me, as shown below, the development he is proposing at that
Ioc &n, and, I have no objections to his proposaL I understand that a pier/mooring
piliags/boatlir't/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 requiremeat.
I j o wish to waive that setback requirement.
DESCRI MON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be JMed in by individual proposing development)
A /
Print or Type Name
/ 7 /_% _
Telephone Numbe_r
Date: /--- -,.,) 1 - � S

■ 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.
Article Addressed to:
P.be�2:t
9.U. 1"-)C)x C113
❑ Agent
(--,d Addressee
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.
41 HestOMIJ Delivery? ped Fee) 0 YeS
2. Article Number 7004 1350 0001 6536 6922
(Transfer from service label)
i
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
i

IVOS
UNITED STATES POSTAL SERVIZ_'O'N-Y First -Class Mail
Postage A Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
PC) � 6(1& 19c)
Hilhd: