47089_BELICKI, ED_20060912

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❑CAMA / ❑ DREDGE & FILL 4
GENERAL PERMIT Previous permit#
12New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commissi m a ar of environmental concern pursuant to 15A NCAC
p�lI ❑ Rules attached.
Applicant Name Y Project Location: County
Address i r ,r C. a? r Street Address/ State Road/ Lot #(s)
City V State ► : C._ZIP 7 95 S'i 1
Phone # O_
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
Fax # (
�V
T EW © PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
El FC:
PNA yes)/ no Crit. Hab. yes / -no
Subdivision � �-k , \ �� , • J .> !� /6
City c c. �.� ZIP A
Phone # ( ) River Basin 'i c .V f < iyt
Adj. Wtr. Body I C t to Z is-e.- (nat7/man /unkn)
Closest Maj. Wtr. Body j\`, F i"C r
Type of Project/ Activity
(Scale: ��' � � � `" i C )
Pier (dock) length 10
Platform(s) X .30-
�T
Finger pier(s) -- - —
TI
- - -
—
Groin length
—
—}--
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
__—
i
— T— ._.,
Basin, channel
cubic yards
y
Boat ramp _
Boathouse/ Boatlift
'
--
Beach Bulldozing
-- - - ---- -
Other
I
I
Shoreline Length
SAM not sure yes now
Sandbags: not sure yes no
j
I_
Moratorium: n/a Yes, n°
Photos: yes
Waiver Attached: yes no ----
---
---
-- -
A building permit may be required by:
See note on back
regarding River Basin rules.
Notes/ Special Conditions
c
re
DEC 13 2006�r.��
Agent or Applicant Printed Name (h Permit Officer's Signature
Signature Please read compliance statemt on bac o permit enIssuing Date Expiration Date
* ).too { r. 600 �3A I PG",\�I(. CU .
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 [)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 ❑ 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

4
Adjacent Riparian Property Owner Statement
(FOR A PIER/MOORING PILINGSBOATLWfBOATHOUSE)
I hereby certify that I own property adjacent to En. is
Name of Property Owner
preppy located at
Lot, block, road, etc.
, in 0(2xEI'1 i Vq , NC
on - 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)
Spc--IA+ tC
0 (.0 VYIT
l E
Print or type naWe
25z-2,1+9-0�'�t
Telephone number
Date
hup://www.innerbanks.biz/arpos.htm 1/29/2006

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7005 1820 0004 6653 2005 rosTaL sFavrcF
ill L�
V �OOn '� 01904
to �c� Lz(�D
cam,
2lt Not!-*
b.S. POSIPGE
PAID
ARAPAHOE.NC
28510
AUG 17.'06
AMOUNT
$1.61
n0096045-02
NZXZE: 0 1 L .)s
METURN 'TO SEeNCIER
UNCL_AxmE E
UNr' ML_E. '70 FORWARD
MC:
f.j_1AP—O 14IS19b

■ 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:
i U k>'a2r1 �O fJ�s.�E
2. Article Number
(Transfer from service label)
i PS Form 3811, February 2004
A. Signature
X ❑ Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7005 1820 0004 6653 2005
Domestic Return Receipt
102595-02-M-1540,

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P.O. BOX 190 ORIENTAL, NC 28571
OFFICE [phone] FAX [phone]
WEB SITE "ww.innerbanks.biz EMAIL info(a.innerbanks.biz
Dear Sir/Maam,
Enclosed is an Adjacent Riparian Property Owner Statement. We are required by CAMA to
notify the owners of the adjacent properties so as is this letter is purely notification of our clients
intentions of building a structure on the water ie. Pier, boat lift, seawall etc. The structure will be
within CAMA's guidelines as CAMA has the ultimate decision to accept or reject the proposed
project. The statement is our proof that you have been notified of our clients intentions. We do
not require any waiver from you personally for this particular structure, so if you would be so
kind to sign the form and return to us in the enclosed envelope, it would be greatly appreciated.
Thank you for your time.
Sincerely,
Nick D'Ambrosia, Vice President
Innerbanks Marine Construction Inc.

Adjacent Riparian Property Owner Statement
(FOR A PIERIMOORING PILINGSBOATLWF/BOATHOUSE)
��S
I hereby certify that I own property adjacent to c-) NaI me of Property Owner
property located at
Lot, block, road, etc-
. in CEi 4 ►1 , NC
on 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 i
(To be filled in by the individual proposing development)
U Cfi ii�YbT .
Signature
Print or type name
Telephone number
Date
http://www.innerbanks.bi7Jarpos.htm
1 /29/2006

Innerbanks Marine Construction Inc.
(Piers, Sea walls, Boat lifts, Permits)
Nick D'Ambrosia, Vice President
NC license # 55828
Ph/Fx 252-249-1429/252-249-2429 �8
Cell 252-671-7757
Email [e-mail]
P.O. Box 190, Oriental, NC 28571
www.innerbanks.biz

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2321
INNERBANKS MARINE CONSTRUCTION, INC.
OX 190 PH. 252-249-1429 66-30/531
P.O. B 71 7 472
ORIENTAL, NC 285 C
DAT 111
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Dec 13 OG 12:02p
Innerbanks Marine
252-248-1429
p. 2
0
AdJ acent Ripanan Property
owner Statement
(FOR A plEWMOORING PILINGS/BOATL'FT'BOATHOUSE)
adjacent to that i own property
I hereby certify Name of PrOPerty 0"
property located at
Lot, block, road, etc.
1, NC
in
on C"?, - -, v�- Town and/or county
wateroouy ow, the development he is proposing at that location and I have
He has described to me, as Shown be'
no objections to his proposal_
OQ_not wish to waive the setback requirement
t do wish to waive the setback requiTenlellt-
Description audlor Dravviag of proposed Development
!To be filled in by the individual proposing development)
LA
Siature
rint or type name
Telephone n 7 ber
Date
http:,/Www_inne,rbanks-bi7Jarpos.ht M.
bcxz-) LJ.A is
1/29/2006