42484_SLOAN, TIM_20050804

L'CAMA / D DREDGE & FILL ll _.
GENERAL PERMIT
Previous p it #
CNew LIModification -I Complete Reissue ❑Partial Reissue Date previ s 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 i SA NCAC
❑ Rules attached.
Applicant Name_ -T 7 LA Project Location: County__
Address Street Address/ State Road/ Lot #(s) /
City i%UL � )c A' State -` 'C ZIP
Phone # ( ) % `�� Fax # (`) Subdivision
Authorized Agent K,/-j3, ,.I 1+6L4Ie City k-,=' ,, F e - U _ ZIP � '`• `��f
❑ CW CEW fPTA ❑ES ❑PTS Phone # ( _') ,, /� 'y��`� River Basin '✓�'r 'S
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body(fiat /man /unkn)
PWS: ❑FC: 'LL2 �-'
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body c' r
Type of Project/ Activity
(Scale: )
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
SAV: not sure yes no —
Sandbags: not sure yes no
Moratorium: n/a yes ,na
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
,3 �r147
Agent dr Applicant Printed Name 4% �•
See note on back regarding River Basin rules.
i /y
Permit Officer's Signature
Signature ** Please read compliance statement on back of perfnj
Application Fee(s) Check #
Issuing Date
Local Planning Jurisdiction
Expiration Date
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 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
_] Tar- Pamlico River Basin Buffer Rules E I Other:
_I 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

MEDFORD MARINE CONTRACTORS 0
9
-o3 484
ROBERT N HASKINS, SR., GIL HASKINS
410 CHURCH RD. 252-635-5242
NEW BERN, NC 28560
NC DL#-444-033 DATE 66-30/531
112
PAY
TO THE
-,
ORDER OF
-COLLARS
H Rs-r CITIZENS 112
,an, Bank & T,-t C—p—y
13ANK C 20562 11
ic - L
FOR --- NP
110000484112 1:0 S 3 100 3001:00 L I L 24 3 4 9 9 GO

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOIL A PIER / MOORING PILINGS / BOA TLIFT / BOATHOUSE)
I hereby certify that I own property adjacent to � 's
(Name of Property Owner)
property located at
on
(Waterbody)
block, Road, ect,.)
(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 roust be set back a minimum distance of fifteen feet (15')
from my area of riparian aces unless waived by me.
Ido unt wish to waive the setback requirement.
Ijda wish to waive that setback requirement.
DESCRIPTION AND / OR DRAIAING OF PROPOSED DEVELOPMENT:
(To be filled in by indh dual proposing development)
( See the attached drawing )
Signs re—
Print or ype Name
�?7.2f7(J
Telephone Number
7,
Date

ADJACENT RIPAR][AN PROPERTV OWNER STATEMENT
(FOR A PIER / MOORING PILINGS / BOA TUFT / BOATHOUSE)
I hereby certify that I own property adjacent to �f /''� S t � � �� _ '5
(Name of Property Owner)
property located at
-- (� B664 !toad, K-L)
on T fi rG �� , is 1� /�✓ . N.C.
(Waterbody) (I"o-av dad / or County)
He has described to me, as shown below, the development bt is proposing at that
location, and I have no objections to his proposal. I understand that a (pier / mooring
pthugs / boathft / boa0muse mast be set back a minimum distance of fifteen feel (15')
from arty area of riparian access utriesr waived by a*.
—_.,,_ I A&j" wish to waive the satbft-k requir t.
I A& wish to waive that setback requirement.
iDESC'REMON AND / OR DRAWING OF PROPOS" DEVIELOPMENi'�
(To be, hear In by im*vldual propa WS devakpmmr)
( See the attached drawins )
Sipoture
Priat or Type Nawo
z r2 . j`i c/. Cq 7 K
Teiepbo" Number
7//3/6 1~ --
to

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