40940_PEASE, ROSS_20050217

CAMA / -i DRU3GE & FILL / �(
GENERAL PERMIT
Previous permit #
❑New � 'Modification �-]Complete Reissue ! IPartial 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
Rules attached.
Applicant Name_ 1 / <" Project Location: County
Address ` ? s Street Address/ State Road/ Lot #(s)
CityState ZIP
Phone # ( ) �'Fax # O Subdivision
Authorized Agent :0' City_ _ _ ZIP_
Affected D CW [�f� D-PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): —I OEA ❑ HHF ❑ IH ❑ UBA ElN/A Adj. Wtr. Body �'' ` { gnat /man /unkn)
1 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
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
Signature "Please read compliance statement on back of permit"
(Scale: ) I
6
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
P,O�
Local Planning Jurisdiction Rover File Name
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, 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 (910-395-3900) 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
15 I -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

4 r
INNERBANKS MARINE CONSTRUCTION, INC.
P.O. BOX 190 PK 252-249-1429
ORIENTAL, NC 28571
PAY J
TO THE 1j
ORDER OF---
-
DATE I G J
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FIRST CITIZENS a72
D A AjV Frtst-Citizens Bank & Trust Company
j jr'si �Il Oriental, N.C. 2SS71
www.firstcitizens.co }�✓ C� �%�
FOR
II'00 18 16u1 ':0 5 3 L00 3001:004 ? 1 20 1 28 2 2ii'
1816
66-30/531
472
$ i oc)l CMG
DOLLARS 8
NP

,t3 u j rn,-,=141 1VrALUA n rnUrEK 1 Y V W NkA b'lAl �'�LY hN-1'
(FOR A PIERIMOORING PffMGS1B0ATLIFT1R0ATH0IISE)
I hereby certify that I own property adjacent to�� p 's
Name of Property Owner)
property located at e - �� A � Y� t 4 � � -
(Lot, Block, Road, etc.)
on Yn E-UsE, rr t,06Yc . , in 6kltC- k C �'a \ , N.C.
(Waterbody) (Town and/ot• 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
pffings/boatIiit/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 coo wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPNEEN r:
(To be , f Iled in by individual proposing development)
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Szgnature,,
Print, or Type Name
Telephone Number
Date: / - �)- C-11 0
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tijL;v ►%,r t41 xL rHx>t p►iv rKVYL' K1 Y V WNEK 61A1'JjN ENI'
(FOR A PIEWMOORING PILINGS/BOATZIFT)BOATHOIISE)
I he:zby certify that I own property adjacent to r.f, P� .� 's
(Name of Property Owner)
property located at wu� ' . ,
(Lot, Block, Road, etc.) -
on r) riz) s E a a,v C.'? . , in _ C> aTc' A , . N.C.
(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 understand that a pier/mooring
piiings/boadi t/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 jo wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be ,riled in by individual pmposzng development)
Iu a- wNNv-acv&?, %.
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INNERBANKS MARINE CONSTRUCTION, INC.
Licensed & Insured
DOCKS, SEAWALLS, PERMITS, BOATLIFTS
P.O. BOX 190, ORIENTAL, NC 28571
PH. 252-249-14291 Fx. 252-249-2429
WWW.INNERBANKS.BIZ
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Signature
Print or Type Name
Telephone Number
Date:
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VIVIICU JINICJ 1 VJlt%L I 11111
ruz:iQ.Idss rvlon
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box °
()yL;�-Gn vA1, nL. P S S '-) �
■ 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:
is q b
A. Signature
X ❑ Agent
❑ Addressee
B. Received by ( Printed Name) C. Date of Delivery
D. Is delivery address different from item 17 ❑ 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.
(eEo� e) 14. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 'ZnnLL rt C r a 0000 3921 6484
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540