39375_GINTY, TOM_20040811

❑CAMA / ❑ DREDGE & FILL J C
GENERAL PERMIT Previous permit #
❑New [-]Modification L Complete Reissue ❑Partial Reissue Date previous permit issued '=f
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
CJ Rules attached.
Applicant Name o h^
Address -? " , /` i K/ JL. n@
City- Y 4 ► c l State 14zip g-?-7
Phone # (f `) Fax # ( )
Authorized Agent
CW is L* �A (� ElPTS
Affected AEC(s): OEA ❑ HHF El IH ElURA ❑ N/A
❑ PWS: ❑ FQ
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County ✓u ,'
Street Address/ State Road/ Lot #(s) tl)-� Y " �y
Subdivision .9.1c <''`"'"''& / t(-"'?_"
City () / / 17_' J` ! / J J ZIP 1 -71
Phone # O River Basin
Adj. Wtr. Body t man unkn
Closest Maj. Wtr. Body
Type of Project/ Activity r (Scale:
Pier (dock) length—
i
Platform(s)
Finger pier(s) -
Groin length
number
Bulkhead/'R`Iipra ength dis ce av offshore
max distance offshore J1 f
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no 'I
Sandbags: not sure yes (no ?
Moratorium: n/a yes (no
Photos: yes (no
Waiver Attached: yes O
A building permit may be required by:
Notes/ Special Conditions j
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L�d'See note
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on back regarding River Basin rules.
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Agent or Applicant P9rinted Name /
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Signature Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit OffflOr's Signature
P 04 �( /1- Yv_•o Lt
Issuing Date Expiration Date
Moorp/z �
Local PlanningJurisdiction IRover 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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- mlico River Basin Buffer Rules I__I Other:
c-� use 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 (252-946-648 [)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

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INNERBANKS MARINE CONSTRUCTION, INC.
1668
P.O. BOX 190
ORIENTAL, NC 28571
252-249-1429 Q �U
1 r 66-30/531
PAY ,r DATE 472
TO THE
ORDER OF \ t � DEN(�
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a�' DOLLARS
FIRST CITIZENS 472
BANKNK First-Citizans Bank & Trust Company
�'1��■` Oriontal, N.C. 28571
www.(irstcitiz``e__ns.com j Ci'�j Ci rnt i % •�Q I% ' �"
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tUJJti%,�ty1 IurA Alv rnUrTIKI Y VWINJt.AK LMAItMt1NT
(FOR A PLERIMOORM PILINGS/B0AT=1R0A7710USE)
I hereby certify that I own property adjacent to l a �n % t v N y is
SBoa 2 (Name of Property Owner)
property located at L 149 C a V"\ R (�, S S V � . -\) c.
y (Lot, BIock, Road, etc.)
on 5\Aw ��c��t , in Uv �"���, , 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
pilmgs/boattift/boathouse must be set back a minimum distance of fiftera 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 AND/OR DRAWING OF PROPOSED DEVELOP EN-T:
(To be Riled in by individual proposing development)
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J�rox>
��J�NN1% 1�. %�l¢•v�io•t/
Print or Type Name
Telephone Number
Date: L/5`1 IV

rLvi.H%.ru-4 z zu-rH rc p► l rKVi Kl Y U WMAK ,'1 A11MklNT
(FOR A PLERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to oiYN 6 c�� 's
2 gj r-J (Name of Pi operty Owner)
property located at
(Lot, Block, Road, etc.)
on f��� ����W ��c�1L , in 0^. v����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
pilingslboatiiftlboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
b-�J 1)oA
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual pmposing development)
AN,0x, W
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Signature
U /'4Tr C
Print or Type Name
.:Z5-2-z41-OSW
Telephone Number
Date: