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GENERAL PERMIT
Previous peispermit
#
1DNew Modification ❑Complete Reissue ❑Partial Reissue Date previo issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources l —
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
f C-Rules attached.
Applicant Name <% Project Location: County (-z,--—`—
Address / k y /" `` •:� . �. Street Address/ State Road/ Lot #(s)
City p ✓ e State) ZIP ` J s' p
� C1Ly"7'—Cri �� �k� •J
Phone # (I' j Fax # (,) Subdivision
Authorized Agent �"'�' '�—'' City_ ~ ' ' ` ''� ZIP
'J
Affected ❑ Cw [Z 4 [9 PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA El [-IIH ElUBA ElN/A Adj. Wtr. Body i ' �' na[ man unkn
ElPWS: ❑FC: r 1
11 Closest Maj. Wtr. Body /11
ORW: yes / no; PNA yes / no r Crit. Hab. yes / no
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
Agent or Applicant Printed Name Pen
-L
(Scale: /V 0 r'l )
-
U '
See note on back regarding River Basin rules.
wmcer s aignawre
Signature ** Please read` compliance statement on back -of per t" Issuing Date Expiration Date
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 I) 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
Iandowner(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 consistentwith 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 (910-395-3900) for more information on how to comply with thesebuffer 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 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

07/06/05 09:34 FAX
Z02
ADJACENT RIPARIAN PROPERTY OWNER STA7`ErAENT
(FOR A PIERIMOORING PILINGS 9e)A7 Z IJW'r/R0ATHO USE)
I hereby certify that 1 own PfOPertY 84jucenttn Al Pa ett ,s
(Name of property owner)
ProPcM ilocated at 103 r ml L.
(Lot, block, road, cu.)
on CLtb&lAt� . inHaVILackl N.C.
(Water body) (Town And/or county)
He has descrt-tied to nw, as shown below, the development he is .Proposing at that
looetion, and, I have no objecdow to bis proposal. I understand that a pierlmooriAs
It pilingslboatlift/boathouse must be set back a mirrimum distance of fiftc= feet (15') from
my area of riparian seem s unless waived by me.
I do not wish to waive the setback requu:vnw t.
I do wish to waive that sctbaak requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT;
(w be filled in by i„divldwal proposing dew-1PpnwW)
to
Ho
6
Foley & Foley Conu ctors, Inc.
PhoneO#: [phone]
Fax#: [phone]
E' d EZB9-E6£-Z97_
4 rem 1z
1
Sigmature
1
print or Type Name
Telepbone Number and Date
eiyaJi'd wol evl 90 90 6o Inr

07/06/05 09:34 FAX
1203
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PLLINGSBOATLMTBOATHOUSE)
I hereby certify that I own property adjacent to Al Padgett _ 's
n� (Name of property owner)
KJ
property located at 103 Bimini Ct.
(Lot, block, road, eta)
on Clubfoot Creek in Havelock/ Craven N.C.
�(Water body) (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 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-
1 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filed In by individual proposing development)
,L car k
d LAI
`n Roar
�'t(t Tvm F
Foley & Foley Contractors, Inc.
Phone#: [phone] Signature
Fax#: [phone] A () &V
L I
Print or Type Name
HqN
Telephone Number and Date

CI J e
FOLEY & FOLEY CONTRACTORS INC.
PH [phone]
1810 OLD AIRPORT RD.
NEW BERN, NC 28562
PAY
m TO THE
ORDER
nu ced docu neat. g�-
1961
DATE (/ 7 —2, ? Q 66-112/531
01901
LL
DOLLARS 8 ;
BRANCH BANKING AND TRUST COMAANYELffE BUSIN SNEW BERN, NORTH CARj J® 2 �, .•yy--tt �l CC�t t
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