45771_MASON, TOM_20060617

❑CAMA % ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previo p rmit 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 I SA NCAC_
❑Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City �' `"� State ZIP
Phone # ( J) "' ! i r r �' Fax # ( ) Subdivision
Authorized AgentCity ZIP
Affected ❑ Cw Q'EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin '
AEC s : ❑ OEA ❑ HHF ElIH ElUBA ElN/A Ad'. Wtr. Body `
i y (nat /man /unkn)
❑ PWS: ❑ FC:
Body —
Type "
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. .
Type of Project/ Activity
(Scale: A )
Pier (dock) length
Platform(s) _ —
Finger piers)
Groin length i
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 r
Photos: yes noWaiver Attached: yes no — -- -- _ - -- ----
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
JI.IN 6 200�-e
Agent or Applicant Printed Name Permit
=er's Signa
— ') s
A
Signature Please read compliance stateMent on badMW�Jw is n aae' 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules Fj 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
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,
Onslow -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.
IN Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
(Z-+`V1(-'9CD G-I m ex-0
mv� V-)Opr"b L-0 VIA. 0Jt(0
A. !rre ,
X 0 Agent
Addressee
e. eceived by (Printed Name) C. 139fe ofbelivery
4— a
D. Is delivery address different from item 111 0' Yes
If YES, enter delivery address below: ❑ No
3. Service Type
,iicr �ertified Mall 0 Express Mali
0 Registered 0 Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
j 2. Article Number 7004 1�350 0001 6536 8704
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
11 Sender: Please print your name, address, and ZIP+4 in this box 0
'To,,<
P.0.6' .� ' 10to
0 Q-TG- wV41, VIC, �s S-1

Adjacent Riparian Property Owner Statement Yage 1 of i
Adjacent Riparian Property Owner Statement
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 'Toni ' 6n is
Name of Property Owner _
rP
property located at Lc. # 1 L� hO � Yl 4" V—bQQ ���� c iL �
Lot, block, road, etc.
on (�XLc ns G2e F'V— , in m ray''—yy . , 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 I do wish to waive the setback requirement.
Description and/or Drawing of Proposed Development
(To be filled in by the individual proposing development)
WATE
Pael� IS-F t
b
Print or type name
Tele hone number
w�
Date
00VI .
http://www.innerbanks.biz/arpos.httn 1 /29/2006

INNERBANKS MARINE CONSTRUCTION INC.
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PO BOX 190 ORIENTAL, NC. 28571
OFFICE [phone] FAX [phone]
EMAIL infon_n,innerbanks.biz
www.innerbanks.biz
Applicant Name
Address 1-77
City c J A-'� State N� Zip S S
Phone# tA (I - U 1
Agent i �x
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INNERBANKS MARINE CONSTRUCTION INC
P.O. BOX 190 PH. 252-249-1429 IE
ORIENTAL NC 28571 \ ���' `,'� _ ,�,% 86-3o/53Z
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PAY _J Z O O
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ORDER OF
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FIRSTCITIZENS
Ftm Bank 8Trust Company
On.ntal, N.C. 28571jjArVK
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