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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
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules IN 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:919-733-1495
Morehead City Headquarters.
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: 252-247-3330
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. ,
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
RECEIVED
APR 0 9 2015
Mar 27 201.5 10:51 i`#W#LESINSKI#DDS 7574802282 p.1
I hereby ceMfV that. i awn property od*ent to
C
LAY— N.C.
The appkent him dewiibed to me, as shown below, the development proposed at the ai OM
! We no $bjocteon to this propossi.
I have ololons to this proposal.
-'•r�r rr.rrrrer.+w�s
DESCRIPTION ANDVOR DRAVANG OF PROPOSED DEVELOI;AENT
(Inr/fuld,usl proposing dune#®pmwW mew 01) In devedptlen bekw or aftch a s to drswing!
RECEIVED
APR 0 9 2015
�O�►►u-wun� ryr�y
YiIAtVEItt S£ IMM
I undwatand fti a pier, docks, mooring p{{irps. breakwaller, boathouse, lift, or groin must bs eat
back a ►nlnimum, distance of 16° from my srsa of Oporfen accass unless walved by me. (if you
wish to walv+e the setback, you must MW*l the appmpdate blank below.)
l do wish to waive the IF setback regitimmsnt.
i do not wish to waive ft I& seibaeCk requimrnw t.
(Property Owner Infor ad6n)____-- _
sr
Pdr,t or hype Name
(Adjacent Property Owner Information)
ILI
�t or ry,�, Narne --
Volddam
� VACINY
MWOMP
R dv
Telephon.lbumber �.
DW#
(Roo o*d av M012)
60 3EVd AdV70 M 9rvdo GObTgZt�S7- 5`:12 t7laZ/ &Z16
ADJACENT RIEAHM PROPERTY gWNIER STATTgMENT
f hereby certify that I own property adjacent to JMA) LU . 6 Q*-3J3�y
(Name of Property Owner)
(Address, Lot, Bioclk, Road,x etc.
on .90 O�_',� .In N.C.
(Waterbody) (Cityf own and/or County
The applicant has described- to me, as shown below, the development proposed at the above
location.
G; I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION} AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndlviduai proposing development crust fill in description below or attach a site drawing)
RECEIVED
APR 4 9 20b
0-0-0mp fwU'Y
WAR SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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.)
I do wish to waive. the IV setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information)
Si
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Print or Type Name
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Print or Type Name
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Mailing Address �G
CiVy StateZp
?.52--_71 L ` Lam?
Telephone Number
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Date
(Revised 6/18/20f2)
Page I of I
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RECEIVED
APR 0 9 2015
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37 Feet
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Parcels - Updated 4-01-2015
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