51589_SANDERFORD, LARRY_20071022

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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
landowners).
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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

North L: d. i L: k I 1 C.
Michael !_ t.asiE:'y': Goi/error
Applicant al'M
—I Nlnfiw'
U�C�de�1��1IrC Ui:�?h-.11,YCI VI f�ijj�i 1G�1,;. Altliu � yutiu� �+
ion
Charles S. ,zones, Diract-or
s tck rI 'b 6gzVw-'N
Mailing tisd; e, �a_
-- / ' C cc-"'
William G. Ross Jr., Secret iry
(I certify that I have aaatbo ize:l (agean9;) �� B t►� B to act oar+ tw
behalf, for the paaa-pose of applying for and obtaining all CAlVMA Permits necessary to
install or construct (adh'ity)at (location)
This cerbfication is valid thru ,date;
Siganataa,re

09/10/2007 15:22 19192331007 IMPRESS 0316 PAGE 02/02
ADJACENT RIPARIAN PROPERTY OLIFT/Bb ATEMENT
(FORA PIER/MOORING P1UN
o ertadjacent i•o 4N11eeeby certi(that I owii ramSA '
of Troy
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property located at �
(Lot, Block, R.oad, etc.) reh
a C.
on�--t� and/or� o nh')
(W aterbody) ---
n below, the development he is proposing at that location, and, I
He has described to me, as show
have no objections to his proposal, i understand that a pier./mooring pilings / boatlift / boathouse
must be objections
a znin`i"i pro distance of fifteen feet (151) from my area bf riparian. access unless
waived by me. (If you. wish to waive the setback, yoU must initial tl�e appropriate blank
below.)
I do not wish to waivc.
C I do wish to waive that setback requirement. ----- ----
--------------
_ --------------
DESCRIPTION AND/Olt DRAWliVG O YItOPOSEA DEVELOPMENT:
(To he f lled in by individual proposing development)
Ul
Print or Type Name
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/NIOORING PILINGS/BOATLPFYIBC+ATHOUSE)
I hereby certify that I own property adjacent i.o
(�i acne of Property Owner)
property located at 5 � eW 1—V�
c•��-i � l
(Lot, Block, Road, etc.) 0 �8 `
on' , mCN m v� CAP in I—U4,IATICje(- ' C-- � �• c
(Waterbody) (T&l and/or County) O
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
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.) j
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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".01 k n
�1` S
-- ------------------------
0't"'Z'Z� �4 >3IL�
C) Signature
�L / t
cu
Print or Type Name
(9/'?) g5/-3.�.27
Telephone Number
Date: _ ��3 �y 7