44597_HILLER, SETH_20060316

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CAMA / ''DREDGE & FILL
GENE L PERMIT 4 Previous permit# !
I—iNew C ] Modification C' Complete Reissue f IPa al Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources j
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
A licant Name Project Location' County
PP
Address
City_________
_
-----.----StateZIP—
Phone # ( ) _
Fax # ( )
Authorized Agent
Affected E Ccw
—' EW PTA _; ES J PTS
AEC(s): ✓ l OEA
HHF IH -- UBA ❑ N/A
❑ PWS:
JFC:
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
Street Address/ State Road/ Lot #(s) ✓
Subdivision_ _ — _
City. ------
Phone #
Adj. Wtr. Body
Closest Maj. Wtr. Body
-- ZIP -
River Basin
(nat Jman /unkn)
(Scale: )
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:
_;' See note on back regarding River Basin rules.
Notes/ Special Conditions
rip 41
Agent or Applicant Printed Name c) Permit Officer's Signature
Signature ** Please read compliance statement on backof permit ( f •+ Issuing Date Expiration Date
r:
ApplicationFee(s) Check# Local Planning jurisdiction Rover File Name

i
4
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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules ] Other:
El 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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/ 1-888-4RCOAST
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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

■ 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:
C.
A. Signature
X , ``; -
B. Received by ( Printed Name)
ent
a O Addressee
C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3, rvice Type
rtifled Mall ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1350 000� 6537 6600
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

`r,il. /; ,
UNITED STATES POSTAL SERV19EPr^ C
9
First -Class Ntail
Postage &,fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
`Z1- 16
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r
■ 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.
1. Article Addressed to:
C) YIL - 'sue 10.
A. Signature
❑ Agent
X ❑ Addressee
B. Received by ( Printed Name) C. Date of Delivery
D. Is delivery address different from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
RCertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
N 7 o E �� ) 14. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1350 0001 6537 6594
(transfer from service label) ----
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540 ,
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Innerbanks Marine Construction Inc.
(Piers, Sea walls, Boat lifts, Permits)
Nick D'Ambrosia, Vice President
NC license #55828 I�
Ph/Fx 252-249-1429/252-249-2429
Cell 252-671-7757
P.O. Box 190, Oriental, NC 28571
www.innerbanks.biz

Adjacent Riparian Property Owner Statement Page 1 of 1
Adjacent Riparian Property Owner Statement
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Jt-;-TV +47VA -,Q . is
Name of Property Owner
property located at (, LT t "S 'T--� T(5 tic ,lam V- C
Lot, block, road, etc.
on , in r" � � tM 1-),, , NC
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 objections to his proposal.
I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be filled in by the individual proposing development)
i
VA T�
I�
i
Signature
V/
Print or type name
Telephone number
Date
http://www.innerbanks.biz/arpos.htm
1 /29/2006

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P.O. BOX 190 PH. 252-249-1429
ORIENTAL, NC 28571 "; \,. ,. 66 30/531
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