38350_TRIPLE S PARK_20040517

CAMA / ❑ DREDGE & FILL
.. GENERAL PERMIT
Previous permit #
❑'New ❑Modification ❑Complete Reissue ❑Partial 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
j1
Applicant Name /� .r"f� f %�' r�y' r� ✓
❑ Rules attached.
Project Location: County
Address! f �~�' ?� <<
Street Address/ State Road/ Lot #(s)
City ,1 i6 u f 6"o r� State ,,J' ZIP
Phone # (' `z) / / t ? 3 Fax # ( )
Subdivision
Authorized Agent Ila F
City ZIP
i
Affected E CW O EW M PTA [IES I] PTS
Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body F 1 c v N CF (fiat
/man /unkn)
❑ PWS: ❑Q F
�r
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body r c`
Type of Project/ Activity 1 �?;: / f PF N ✓.. ,r` o ; �€ ; 1� .
(Scale: �r )
Pier (dock) length_
Platform(s)
Finger pier(s)
Groin length
number
B Ikh .old/ Riprap length
—�
avg distance offshore t
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing
Other
rV ZA �f1C• ��/ !�. n� V. rj! t/ pv. lI/ „
�_ �� G ►- gyp �' rl ?/' �' +� S "G1(.� v I � V . -�, , I'i, %, `, l.. f �.'�� ; �- c
-1 s� Y
i
r Q'� r/(; r/t +^�/ !v r f ��e.. +Tre
Ali #�r� iJ�j�t, r nc `� r,F I� (vi i(
E
Shoreline Length
-7 "'�-• �. s�'!
it i .�` y� /t �l . ��P r/F
SAV: not sure yes
Sandbags: not sure yes
I---
frrub
✓ ,,1 _!y - ld rt ( f l f
/ - --
d '/ �k a I.�, I I no 7 < ✓ r.
Moratorium: n/a yes
r9
Photos: yes
no
t
t1 f�I �t
Waiver Attached: yes
no
-------- -
- -- -- - ---- - -- - — -
A building permit may be required by: P,?e 41 t t 1l L
See note on back regarding River Basin rules.
Notes/ Special Conditions
IIFe
Ne t10le N Uc cl N� rr �p� I" 1�
(/,�'��i� �: /�< • <{; (�
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date
Expiration Date
/II/ftM l4.rt
7G5C Yl m
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
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 / 1-888ARCOAST
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/OS/0I

MUD BUCKET DREDGING, INC.
ATLANTIC BEACH CAUSEWAY NCDL 8039839 3878
PO BOX 3355 PH(252)726-2191
ATLANTIC BEACH, NC 28512 n
Date zt,.fy 66-30/531
Pay to the / I 133
Order of C
�I i'IFiSTCITi7,ENS-»> Z/O
[2 (� I� I K- %sr Cirrzons Bank 8 Trust Company
13 al �' I� All antic 80ach. N C. 28512
fJwww.firstcitizens.com
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TRIPLE S MARINA 252 247 4807 04/07/04 11:SSPm P. 001
:f
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify *'tat I own property adjacent_ to �47,cIB33
4/p �b`��jl err S iproperty
located at
! S/ yj9w oar! 'Qd on
Block, Road,
in �� own and./� County)
(Water Body)
He has described t_:a me as indicated l-lelow the devel-opment
he is proposing at that location and I have noobjections
to his proposal. I ta�derstand that a pier, pilings
dredging must be set Dack a minumum distance of fifteen
(15') from m area of riparian access unless waived by
I do not wish to waive that setback requirement.
jl I do wish to waive that setback requirement.
— pescription and/or drawingof rpj'_osed develo mp ent-
(To be filled it Y
�. individual proposing development_)
(A(Sf-,4,L .AIV)o14 'D 30� Gl�! �, of UrKyt_ 46g"4.1-
�76¢.�o,¢i4�fE0 Exrs�iAlf iicJ/.�« ,
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41 -
Date
&-aIgnz,jure
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Print ame
,tea-ay7 - 4P33 �
Phone Number

,Apr-12-04 03:47pm From -BUT Financial Operations 2522465204 T-541 P.001/002 F-132
Hpr 12 04 03:54p 5anad r_`'r-f r -
VA X
ADJACENT RIPARIAN PROPERTY OWNER ST?kTEMENT
I hereby certify t:-,at I own propertY adjacent to
S Property
located at
(L5t, Block, Road, et:v. )
� o � �-�f 2.r r N . L' -
in
(Water Bo y) (Town end/ �r County)
I;e has described t:D me as indicateci below the development
he is proposing at that location and I have no]objecttioons
i-inqs and
to his proposal_ I understand that a pier, p
dredging ust be e,minumum
di-stance
fif
(151) frommy areaotriparianacces5unless �aivedtbynme.
I do not wish to waive that setback reciui.rement-
I do wish to naive that setback requircment-
Descri tion and/or drawing of provased development:
(To be filled zr-
!,y individual prc-pasing development.)
14J,S'r4I-LA-F1014 OG L(L P1. OF
rd a2��o[a C iE� 1 a¢�LfED 6 K 1 Sr1,vf S1 4,W4C L ,
S�e 4rTACN60
Date
Signature. a- --
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Print N e
�269- �q&-5JZS0
Phone? slumber

APR-14-2004 08:32 AM YOUNGBLOOD.CONST 2522400344 P.01
-ter aaip6 252-726-6112
P. 1
12E 7 vez,y ro pAx x Tz - - ^ (o,,17
ADJACiNT RIPARIAN PRQFERTY OWNER STATEMENT
I hereby ce 'rify t-;I&t I own prepg�rt adjaceirt to
property
located at 1 _<!/ On
(L�t, B1oCk, Road, etc.► �� '—
'80ric 00'+0
- A14:.. — 1n stu%r T,q�°N ei2" N-C.
(water Body) Town an / nr County)
fie has desc i.bed t.., me as indicated kielow the development
he is proposing at that location and I have no objections
to his proposd... 1 ulderstaind tnat a pier, pilings and
dredging must 19 set back a minumum distance of fifteen feet
(15') from my area of riparian access unlese waived by me_
I do n)L- wis;!. to waive that set'>ack requict-ment.
I do w.sh t:o waive thet setback requirement.
DesCrlpt_on ane/or drawing of pr:.rosed development:
(To be fil-ed is '_,y individual proposing development.)
(kIS'r4 C.t< A 'r I oa! v G O/ G fLl p or- 0 I4I yl- sEq k�1 c t_
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Date - Yhonf: [lumber w