Bryan, Robert

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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

AMA / ❑ DREDGE & FILL
N ERAL PERMIT Previous permit #'
w ❑Modification ❑Complete Reissue ❑Partial Reissue Date prevous permit is ued
auth • ized by the State of Nor& Carolina, Department of Environment and NaturaE"Resources -
! the Coastal Resourcfs-Ncommission in ag areapf en�ij onmental concern pursuant to 15A NCAC '
R es`attached.
} `f � n J
�Iwant Name Project Location: County Cr
dress !A Street Address/ State Ro*Lot #(s) ,
State t I P"
`_Ma ilg"`'-^.�""""° Subdivision
hor`ized Agent "`} 't 1 ' ' I r°' City E' i, 4 ' ZIP
BCted ElCW ElEW El PTA KES ElPTS Phone # (' 3 r ' vei Bas n ❑OEA ElHHF ElIH BA ❑ N/A r; 4 ,
Adj. Wtr. Body ' ' hat an unkn
W e ❑ Py PNA yes Closest Maj. VVtr.`�Body
y,''
pe of Project/ Activity ,r�
(Scale:
ier (dock) length �`�--

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Fobe'4
Mailing Address: 20 '?>oK Sti g ?,S'
. va,4-10- -E-'UI Ile -AJC
Phone Number: AID 8 gf- - aS-'K6
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: luk �kee-4
at my property located at �O 1 'Se)
in Qf County.
l furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Propert Owner Information:
RECEIVED
Signature JAN 31 2017
C. BLLA44VV-
Print or Type Name ®CM- MHD CITY
Title RECEIVED
Date JAN 12 2017
DCM- MHD CITY
This certification is valid through 1 1,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own. property adjacent to __$ C) CV -
located at 4-ka 0
's
(Address, tot,ocli, ad, a#c.)
on C� ,aV , m'. N.C.
Li (Waterbody) (City own and/or County)
The applicant has described to me, as shown below,`the.development proposed at the above.
loc tion.
' I have no objection to -this proposal. '
_ I have. objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROP' OS9D DEVELOPMENT:
(Individual proposing development must fill`In descr�p. on below or aiiach asife drawing)
w
�5e 1 ��
u f
00
Avl
WAIVER SECTION l
un erstand that. a pier, dock, mooring pilings, breakwater, boathouse; lift, r groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you , '
Wight w ive .the.setback, you must initial the appropriate blank below.)
I do vinsh .to waive the 15'setback requirement. RECEIVED 1
1 do not wish to waive the 15' setback requirement. )AN 1 2 2017
(P erty Owne Information) (Adjacent Property Own
0laaaD CITY
Sign tur Sign e .
PM' t r Ty Name Print or Type Name Al
�1GT^—
Add ess if r M ii" g Addr s
OL �.. 5
f
Cdy St to tp CltylState/Zip
sREDEIV
ED
T phone N her Telephone umber
Date Date
D (Revised NMM�D CITY

B"V-,l S7'5
Ot
Ve A
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10
f�L W� g
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ro
RECEIVE[
JaN 12 2017
DCM- MHD CI7'1E'