42921_MITCHENER, MARTHA_20051017

❑CAMA / ❑ DREDGE & FILL
29r .1.
GENERAL PERMIT
Previous permit # �'
L7New [:]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 I SA NCAC
Applicant Name ? /'` Project Location: County
Address 175
City State ZIP
Phone # ('�')-��-'"� l/L% Fax # O
Authorized Agent %!
Affected CI CW DEW PTA &ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH D USA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no.,, Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City
ri ftE "it'4Cr7 ZIP
Phone # ( ) River Basin
Adj. Wtr. Body_ (nat /man /unkn)
1
Closest Maj. Wtr. Body s
Type of Project/ Activity
Pier (dock) length
Platf
Finger
Groi
Bulk
Basin
Boat
Boat
Beach-4-k
Other
Shoreline
SAM
Sandbags:
Mo
Photos:
Waiver Attached. yes no
A building permit may be required by: / ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Bulkhead/
Boathouse/
Moratorium:
orm(s)
i I ,
pier(s)i� I_� -
i�! I i
n length
number � I
Riprap length � >!-
avgdistance offshore
max distance offshore
channel
cubic yards �
ramp �
Boatlift
Bulldozing
I
Length
not sure yes no not sure
Yes no
n/a yes no
yes •, noL—
i
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
J Tar - Pamlico River Basin Buffer Rules _J 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 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,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

SEP-21-2005 15:15 FROM:PERQUIMANS FSA OFFIC 252-426-7779 TO:12522403336 P:2/2
ADJACEM RIPARIAN PROPERT
Y OWNER STATE ; `P 2 8 2005
(FOR A PIER/MOORING PILINGS/BLOATLIFT/BOATHOUSE)
Morehead City DCM
I hereby certify that I own property adjacent to MA fk _ t4r�mey $
(Name of Property owner)
property located at ; � 8 r T1 yd
(Lot, Block, Road, etc.)
on E 6 qe �OLknA in G NC.
aterbody) (Town andlor CDumY)
He has described to me, as shown below, the development he is proposing at that
Iocation, and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/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 requirement.
I do wish to waive the setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT;
( To be filled in by individual proposing development)
Signatur
�'
�JL� lie �/avc�
Print or Type Name
Telephone Number
Date
Vblv-�
L�fl��l�u/C

09/21/2005 16:11 7231877 COMMERCIAL OIL PAGE 01
Sep�21 05 02:19p Martha Tripp Mitchener 2522403336 p.2
Ai).TACF,NT WARIAN PROPERTY OWNER STA' 1EMFNT" 005
WQR A I'IFR/,'VtOI)RIiVG PII,INCS/BOATllFr/BQATj�e�F)
IVIPI hereby certify that t own property adjacent to — s
(Nntrle of Properly Owner)
rworzfty locmtc'd at
(l.nt, Block, Road, W-)
on I
(Witrbculy) (17own and/or County)
ve: has describcd to me, as shown below, the devt:1(vn ent he is proposing at that location,
and, 1 h:wt: no ol)jeetions to his proposal. I understand that a pier/mooring
pifia;;.r/lxatiJilt/batlbOUSC n1Ust be; sjx back a rnininuun distance of fifte u-n feet (15') from my area
of ripieriut aeccsg ►inlev, Waived by me.
It tgil wish tU waive the setback requitement.
i 11A wish to waive that setback 1egUirement.
--------------- —-------------------- ------- -----------------
1)rSCK1i''I'i0N ANn/OR DRAWYNG OF PROPOSED T)EVT-,I.OP1V1F N'C:
(7o he filled in ipy irityis. Iial proposing developmerO)
Print or TyFfe Name
'l-ele phone. Number
Date:

OUTER BANKS MARINE CONSTRUCTION, INC
FIRST1501
MOREHEAD CITY, NC 28557
[phone]
PAY THE
ORDER
OF
FIRST CITIZENS BANK
MOREHEAD CITY, N.C. 28557
MEMO
000 1 7 20))s 1:0 5 3 100 3001:00 13 12 16 2 1 2
r
I.
1720
SS-3G/537
�/�=3,- ) 737
DOLLARS
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