41988_RANDALL, BENJAMIN_20050712

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GENERAL PERMIT
ZNew ❑Modification `1Complete Reissue LIPartial Reissue
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
Previous permit #
Date previous permit issued
Rules attached.
Applicant Name V-k, til Project Location: County_ ''14
Address ' f ? J �lS a"� rr Street Address/ State Road/ Lot #(s)
r
City kI rn/G State dJC ZIP , %y .4 ro
Phone # (�� ) i�-2y 162 n Fax # ( )
Subdivision
Authorized Agent
City_ ''' j NCL
ZIP
- x= 79
❑ CW ,� EW -BPTA ❑ ES ❑ PTS
Phone # ( ) % y
�� y_� River Basin
Affected
OEA ❑ HHF IH UBA N/A
AEC(s): ❑ ElElElAdj.
Wtr. Body r
- Aw .-L'„ "' �� '�'
Cnat /man /unkn)
❑ PWS: ❑FC:
ORW: yes / no PNA yes (no Crit. Hab. yes no
Closest Maj. Wtr. Body
>Jy
Type of Project/ Activity —_'-_' , -1
Pier (dock) length_
Platform(s) _-
Finger pier(s)
Groin length
number
Bulkhead/ Nprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatliff
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
it
,ti i 7
(Scale:
<
// / C See note on back regarding River Basin rules.
?� i1. '<�r'ii'-cd l'
Agent or Applicant Printed N q
/IJX
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date
Local PlanningJurisdiction
E
Expiration Date
0-7,/ 2-1' Y �
Rover File Name
l

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:
j 1 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 / 1-888ARCOAST
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

ADJACENT RIPARLA.N PROPERTY OWNER STAMEEN T
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOCSE)
I hereby certify that I own property adjacent to,3,rw,,,4;M11)l J. -R4wQ,#i-,4- `s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc_)
on Ayi)& n t G�1Cj_ L A , in (2 1, i-"1C `6- % � N.C.
(Waterbody) (Town and/ r County)
He has described to me, as shown below, the development he is propoing a: that location,
and, I have no. objections to his proposal_ I understand that a pier/mooring
pilings,'boatlift/boathouse must be se: back a minimum distance of fifteen fee: (1 5') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
C-� I dr wish to waive trat setback requirement.
DESCRIPTION kN- D/OR DRAWL-PiG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
o y LIFT
eRAD�r ,Q�,e�s O
y
- -, /Y-7
\ I
nature
Print or Type Name
Telephone Number
Date: O 7 0g/d'�—

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07/12/05 TUE 11:49 FAX [phone] AFCAA Q 002
ADJACENT RIPARL .N PROPERTY OWNER STA.TEN1L-'*1'r '►1[. l � Zp05
(,OR A PrERIMOORING PIL1jyGs1B0A njTlHoAnvoc"SE ` 4rOheiad City nC
�� M
I hereby certify Char I own property adjacent tabffN ifN J , .�-i '5
(Name of Propel Owns)
prorputy k crated at S :�L.3 l7 '
(Lot_ Black, Road, etc-)
on 1VJ �1 t) �s C%',Cr,� in Ji�d 1 L= L- 7" a' N. C.
a
fraterb ody) U6wn and/ County)
Fie has descifoed to me, as szown below, the development he is propos=u._ a' that location,
and, I have no. obim; ions to his prvpasal_ I under rand tha a picrlmvarin-E
p in,as/baatli€dbaathouse must be � oack a minimum distance of ff=n feet { i �') from my area
of riparian access unlcir' waivc d by mc_
I A%.IIi wish to Asiv-- the sczback requirement
I da wish to wAve teat: setback requirement_
DESCRIPTION AND/OR DPAWL iG OF PROPOSED DEVELOPNMYT.
(To he jed in by Fndv1W proposing development)
r Ln Terry
z
d
i
I�
I
V ' ,
Signature
--J" t-t �
Print or Type Name
7C� (4)
Tdcphonc Number
Date: ! 1 ! Z
10/TB 39dd SV3Z1 :�OHS Nd315a3 666T67_.LZ9Z 99:T7 90QZ/Ee/LB

Anastasia Randall
223 Possum Trott Ph 252-729-I643 66-30/53I
P.O. Box 208 006
Smy-a, NC 28599
PAY TO THE ) DATE ®/ ��
ORDER OF C Q /� f O
2023
0tA���� lot: Micro Print signa11- line, g,'y ype and linework. First C1 ' , ns ank logo on back. I(ool present, do not cash.
7 OLInRS
F A k Fr iz¢na 00B
a.� �ii www. rt, N.C. 28518 N� company � �� �tp�-
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