42736_MITCHUM'S, ANNETTE_20050816

5
C +CAMA / ❑DREDGE &FILL
a
)6
GENERAL PERMIT
Uy
0
Previous permit #
❑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
p l
Applicant Name �.ti��r=7�1(? %; �y/, rckjK-f ��
❑ Rules attar
Project Location: County
d.
Address / /"), /, /"
Street Address/ State Road/ Lot #(s)
City _Z'� V I `i State N ZIP
:'0
Phone # ( ) �� % , ���% Fax # O
Subdivision
Authorized Agent
City ZIPr-
Affected ❑ CW ❑EW KPTA ❑ ES ❑ PTs
Phone # O River Basin
�•�
❑ OEA El HHF ❑ IH 1-1UBA El N/A
AEC(s):
r , ,,
Adj. Wtr. Body � � _%�%UA/L>
gnat _/man /unkn)
❑ PWS: ❑FC:
Closest Maj. Wtr. Body—''�`!�
—
ORW: yes / no PNA yes / no Crit. Hab. yes / no
r
Signature Please read compliance statement on back of permit" Issuing Date Expiration Date
/
Application Fee(s) Check # 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, 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 L_j Other:
Ll 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 (910-796-7215) for more information on how to comply with these buffer 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
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888ARCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

BLUE WATER MARINE 3804 a
CONSTRUCTION INC.
PO BOX 93
MOREHEAD CrrY, NC 28557-0093 66-112/531
DATE �% '-D�_ 02301 ;
a
PAYTO THE
n _
ORDER OF � 1_7—� - _ � IO D • O f� � �r
/CIO
��. S DOLLAR
- - - �,...M ...
BMT
BRANCH BANKING AND TRUST COMPANY
�] MOREHEAD CITY NORTH CAROLINA,
FOR,,L�L�1_.S
113003804u' 1:053LEI LL20:52Lt,986592111

ADJACENT RIPARLkN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOA7Z,1FTIBOATHOUSE)
� �M I I ,
I hereby cer-dfy that I own property adjacent to Ar)n&_4Ae_ VV • 1' li-l-C, om s
(Name of Property Owner)
prope.y located at 14'� W I Lr L IS c) ,
on
(Lot; Block, Road, etc_)
pre_ Sound , in bct Vl 5
(Waterbody)
(Town and/or County)
. N.C.
He has described to me, as shown below, the deve'.opment he's proposi-_ a_ that location,
and, I have no objections to his proposal. I uncle -sand tha_ a pie:/moornE
pdingscaoatlifftoathouse must be se: back a minimum distance of f i-etn fer: (If') from my area
of npan'an access unless waived by me.
I do Tint wish to waive the setback requirement.
I d_Q wish to waive t�.at setback recuirement.
DESCRIPTION A.N-D/OR DRAWr G OF PROPOSED DEVELOP`IENT:
(To be filled in by irzdividual proposing development)
'r ,
r,
/I _Y�/ 6M,9Z.2
C / W
Signature
C I9RoG x/0
Print or Type Name
Te!eohone Number

ADJACENT RLPARL-�N PROPERTY OWNER STATENLEN7
(FOR A PIER/MOORING PILINGSIBOA7ZIFTIBOATHOCSE)
I hereby certify that I own property adjacent to W fA ctlo ' 's
((Name of Property Owner)
propery located at I q� W i g J--t S V2 C
(Lot; Block, Road, etc.)
on CD��- So���� , in
(Waterbody)
(Town and/or County)
, N.C.
He has described to me, as shown below, the development he is proposi-= a: that location,
and, I have no objections to his proposal. I unde-sta:-!d ta: a pie:/ moor'nE
piiirigs,boadif-Jboathouse must be se: back a minimum distance of fiiietn fet' (15') from my area
of riparian access unless waived by me.
I do nol wish to waivC the setback requirement.
I dq wish to waive t;.at setback recuirement.
DESCRIPTION A.N-D/OR DRAWLNG OF PROPOSED DEVELOPNIE.NT:
(To be filled irz by indiv&aal proposing development)
e0;)-�/ IJ
19
OC
fq
v 0
e �
y too
Sian re
Pn t or Type NameW
O's'-.) 7A9-' �
Te.z� phone Numbe-