45153_CIPOLLINO, NICK_20060420

[�CAMA / ❑ DREDGE & FILL �J .
GENERAL PERMIT Previous permit # ;
❑New []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 15A NCAC V
❑ Rules attached. IV
Applicant Name i V "''
Project Location: County
Address J J -x Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # O Subdivision
Authorized Agent City ZIP
Affected ❑ Cw ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body gnat '/man /unkn)
❑ PWS: ❑ 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
0
(Scale: )
Shoreline Length
SAM not sure yes po
Sandbags: not sure yes no-
f_. -- - - — -- -
Moratorium: n/a yes no
It i
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
Agent or Applicant Printed Name 200 Permit Officer's Signature
Signature "Please read compliance statement on b Qri� i City Expiration Date
Application Fee(s) Check # Local Planningf urisdiction Rover File Name

hw
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:
❑ 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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

.Apr 20 06 08:35a Bob a Missy Baskervill 252-249-3537 p.l
Facsimile Transmittal Sheet
To: 2 A , '/ �-A J✓ 2
Company: C,q y�
Fax Number: l
From: Baskervill
Company:
Fax Number: 252-249-3537
Phone Number: 2,52,-2,49-0900
Date: q / 12 a / D C.
11 Number of pages, including cover sheet:
I Comments:
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OA-t�y- I
3
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161
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-Apr 20 06 08:35a Bob & Missy Baskervill 252-249-3537 p.2
ADJACENT RIPARIAN PROPERTY O«R STATEMENT
(FOR A PIERIA100RING PILINGSIBOA?ZTFTIBOATHOUSE)
I hereby certify that I own property adjacent to Ag;-PJ CI a <I j 5 s
Wame 'Of Prope O ner)
property located at
r f J (Lot, Block, Road, etc.) '
on BAN CP2Pl< , in ex-/-,� 1� y
(Waterbody) a dlorr _ '-N.C.
Town
( 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 pier/mooring
pilings/boatliWboathouse must beset back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me. -
I de not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION A.AKWOR DRANNT G OF PROPOSED DEVELOPN ENT:
(To be.illed fn by indfrfdual proposing development)
P
D
G
a V
i1r
12
F
0
--a Signature 1
47 /1 —
Print or Ty Name
r
Telephone Number

Apr 20 06 08:35a Bob & Missy Baskervill 252-249-3537 p.3
ADJACOWT RMAR ATi PROPERTY OWNER STATEMENT
(FOR A PIERIA100RING PIIINGS/BOATLTFT/BOATHOUSE)
I hereby certify that I own property adjacent to V 1 ck 4 Aid ,V C t d //I ID .s
Wame of Properfy owner)
property located atDp
(Lot, Block, Road, etc.)
on ! E ��22 2 !< in eR,e C.
(Waterbody) (Town ai&or County)
- 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
pilingdboatlifl/boathouse must beset back a minimum distance of fifteen feet (157) from my area
of riparian access unless waived by me -
do not wish to waive the setback requirement.
IN
I do wish to waive that setback requirement.
DESCREMON A *LNM/OR DRAiNTiG OF PROPOSED DEVELOPMENM
(To be flUed in by indiridual proposing development)
V ��t Z—
Prints� Ty CNa o 7e Lf 3
n
Telephone Number

d. daC u»i., p 1. S • `u
NICHOL:AS CIPOLIar`'1�
KARINL CiPOLL.INO `'f�
PH# [phone] j� o r
300 QUAIL RD �i� �j cuff ` i`{1 v 66 3D/531
MERRITT, NO 28556 DATE y an
TO THE f"�
ORDER OF
DOLLARS
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FIRST CITIZENS 472 �� ; .tf��f��� �`1 f
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Morehea-d
City DCM
F obert D. Baskervill, Jr.
33,84 Bear>i--Gme4c-Drive---
Araphnis NJ (,- 2851

ADJACENT RIPARIAN PROPERTY OWNER STATEIIMNT
(FOR A PIERIMOORING PILINGSIBOATLITTIBOATHOUSE)
I hereby certify that I own property adjacent to I c I< l�/
s
(Name of Proper Owner)
property located at
(Lot, Block, Road, etc.)
on CA -ee I < , in f RA .gym.' , . N. C.
(Waterbody) (Town -a d/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 pier/mooring
pilings/boatlifVboathouse 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.
DESCRIPTION A-tNrD/OR DRANN'LNG OF PROPOSED DEVELOPMEN r:
(To be filled in by individual proposing development)
4
Print or Ty Name
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PJUNGSBOATUFT/BOATHOUS
I hereby certif that I own property adjacent to t 11 c k �J
-
(Name of Prui�4
Owner) -�,
property located at _300 Q,,,,0„+ 1 ki . .0
(Lot, Block, Road, etc.)
on 3,9 1 1 Cj�,� e %< , in P,e� , .�n , . N.C.
(Waterbody) (Town atidlor 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 pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (I5') 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.
DESCREMON MNTD/OR DRANNT G OF PROPOSED DEVELOP:l1ET'T:
(To he•illed in by indit dual proposing development)
�X15J1"�y
G c / e'
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P� S02 t or Ty Na
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Telephone Number