43479_BLANE, IRA_20051026

C'�CAMA / !-1 DREDGE &FILL 44V
GENERAL PERMIT Previous per it #
C!New i! JModification C'Complete Reissue ❑Partial Reissue Date previo 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
Applicant Name Project Location: County___ __
Address Street Address/ State Road/ Lot #(s)
State ZIP
Phone # (' ) Fax # ( ) Subdivision
Rules attached.
Authorized Agent —' ,' "f (' City--_ ZIP_
Affected 11 CW -1 EW i] PTA ❑ ES ❑ PTS Phone # (_ ) River Basin
i OEA HHF ❑ IH ElUBA ❑ N/A
AEC(s): - - Adj. Wtr. Body __ (nat1man /unkn
_l PWS: i FC: _ -
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
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
Beach Bulldozing
Other
Shoreline Length -
SAM 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:
Notes/ Special Conditions
114P01! /' l)I)!,) �'
�Z
Agent or Applicant Printed ame
Signature "Please read compliance statement on back of permit **
I
(Scale:
See note on back regarding River Basin rules.
Permit0 r'sSignature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
)I
Application Fee(s) Check #

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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Ll 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:
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/ 1-888-4RCOAST
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 maiipiece,
or on the front if space permits.
1. Article Addressed to:
i
A. Signature
X ,7p-- i
❑ Agent
❑ Addressee
B. Weceived by (Printed Name) C. Date of Delivery
D. Is delivery addressdifferent fn,r6qm;t? ❑ Yes
If YES, enter delivery addre"I, ❑ No
3. Serv' Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
0 Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
z. (7ranle r from 7003 2260 0002 1,650 4880
(Transfer from service G
PS Form 3811, February 2004 Domestic Return Receipt 10259s02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
3� r
:' R a z i 1111111111111111111111111!111!111111111, 11$1111111111111111!H

■ 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.
A' 1. Article Addressed to:
mr1Ci1Qdr 05Cs�C'C�,c
N Ru
WF)4eceived
❑ Agent
V11 ❑ Addressee
Tinted Name) C. Ola4, ofilDelivery
v b a 7
D. Is delivery address different from item 1? Yes
If YES, enter delivery address below: ❑ No
3. Serves Type
EYbertifled Mail 0 Express Mail
❑ Registered 0 Return Receipt for Mercha_ Ddise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
` 2. cleNumbe
(Rans rfrom 7003 2260 0002 1,650 4897
(transfer from
PS Form 3811, February 2004 Domestic Return Receipt 102595-02.M_1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print y9ur name, address, and ZIP+4 in this box •
uu

ADJACENT RIPARIAN PROPERTY OWNER STATEMUT
` (FOR .A PIERIMOORMG PILINGSfB4MUMBO.A.MO�`I,
I hereby certify that I own property adjacent to
(Name of Property Owner-)
property located at ZO
(M
(Waterbody)
(Imt, Block, Road, etc.)
in/��1- % �1 Cr , N.C.
('T'ovm 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 understand that a pierlmooring
pilings/boathft/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 that setback requirement.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developments
Signature
Print or Type Name
Telephone Number
Date:

SPRING CREEK CONSTRUCTION
i h 252-249-1819
2398 Whortonsville Rd
Merritt, NC 28556
_ WACHOVIt1
Wachovia Bank, N.A.
wachovia.com
FOR 2, 3 qqL
1:0'S 3000 2 191: 200 ?8 3000
`� 2043
/6 30
/� BRANCH NCH 77512
DATE
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