40752_LUTZ, ANITA_20050203

` '=jCAMA V 7 DREDGE & FILL
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GENERAL PERMIT
Previous permit #
❑New ❑iModification -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_ u
Project Location: County_ ` ry laz-
Address ✓ '� � x t "
1
Street Address/ State Road/ Lot #(s) t..,, -
City � r 1 `_ State ZIP
Phone # ( s ) 1 ' l ` Fax # ( )
Subdivision
Authorized Agent U�/� ,il�,; i r c 6-, j -t
City_ Doe- e— -4 ° I �" c ZIP
-5 ) /
� CW (34 W O'PTA 0ES ❑ PTS
Affected
Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
'
Adj. Wtr. Body
(nat jman)/unkn�
❑ 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 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
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
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
[?tee note on back regarding River Basin rules.
Permit Offic'er's Signature
- >-
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
Iandowner(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 i 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 / 1-888-4RCOAST
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

INNERBANKS MARINE CONSTRUCTION, INC.
P.O. BOX 190 PH. 252-249-1429
ORIENTAL, NC 28571
1811
(0) 66-30/53
DATE 472
PAY
TO THE NCD L N�,
ORDER OF $ C)
----DOLLARS
P
HRS-f CITIZENS472
j3AjNJKFirst-C1t­s Bank & Trust Company
Cki.nt.1, N N.C. 28571
irstcitiz ns.com
NIP
FOR
L8 I Lill 1:0 S 3 LOD 3001:00 to 7 L 20 1 28 2 211l

tuyjtx%,=,j j jLLrp►xuwj'4 rnurL'KI I VWM K,1A LVVI' ML'
(FOR A PMR/MOORIIYG MNGSBOATU BOAMOUSE)
I hereby certify that I own property adjacent to He1:'t.N L u k z- 's
(Name of Property Owner)
property located at u # 6 4 �.�.,�Ce r Y \ . �' � ,
BIock, Road, etc.)
on W1'VAI,k eV in 0 t' ��� �� . , N.C.
(Waterbody) (Town and/oic 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
pdings/boatlift/boathouse must be set back a minimum distance of fif en 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.
DESCRIMON AND/OR DRAWING OF PROPOSED DEV KWF51ENT:
(To be fiZfed in by individual pmposzng development)
�J
SlgIIatUre
Print or Type Name
X 2-
Telephone Number
Date: X z,/-�-o /r

1 i%.WFUUAA rnVrJ!.KI I VWALK,1AlTAM-tV'1'
(FOR A MERIMOORMG PILINGSBOAMTrIBOAMOUSE)
I hereby certify that I own property adjacent to H %-,, \ .N L u } 's
(Name of Property Owner)
ply located at 1 u� #-61 \N'\1\U V- Y \. 2� v
(Lot, BIocJ, Road, etc.)
r
on W`��,��1�e� Cvc k �ti ��� �� . , N.C.
(Waterbody) (Town and/oir County)
He has descn-bed 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
pilhip boatlir7/boathouse must be set back a minimum distance of fiftn feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement
I jo wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEIAP'Vi M:
(To be filled in by individual pmposing development)
.------------
S � `
I
V1i
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Signature
L At /-
Print or Type Name
Telephone Number �-
Date: