Canady, David

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
❑ Neuse River Basin Buffer Rules
❑ Other:
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
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ I-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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.netl
Revised 08/27/ 14

G A , M,
WA.
l
NCDENR
r-lort ; Larc-IN a Department of `nvironment and Natura! ftesourc-cs
Division of Coastal iirlanagement
?vi M,,,CI•o'rj Braxton C. Davis
Director
Date C /S/ zc17
Applicant Name
John E, Skvs la, Ili
SecrataFy
Mailing ddress
I certify that I have authorized (agent) ..mac:. �
to act on my behalf, for the
r .
purpose oft applying for and obtaining all CAMA Permits necessary to install or construct (activity)
�A I .,GI c,G at (location)
2
This cer ication is valid thru (date)
Sign.a
400 Commerce Ave.. Morehead City, NC 28557
Phone: �52-808-28081 FAX: [phone] Internet. www.nccoastalmanagement.net
l
An Eouol bppodunily 1 Affi meGve Adan EMOOyer
FEB 0 3 2017
DCM- MHD CITY
NorthCarolina
.NWAUPtIlly
NOE:9 L101 '[Vuvr

IV
�s
s PREN Q
D.s..C9N i -P>EPAROAN PROPER OjA M�IER SY.s
I 3.-
Aro eny adjacent to (Name of P opec q
er�
i;, ✓f
,, ownthof
rebv cv,�
Rood etc)
r N.C.
o o� !oC=tad at (Address, Mrose�'c&�.4
�u �Gaeyrcwn ar.d/r counaY)
Cxate' ?odV) at the above
below,
?e agglicSn' ha
s described to me• as shown the development proposed
Gtionno obj. a ection to this proposal.
I hav-
ro .
have objections to this p PosalELOpMEN u
��©/®R ®6Z.,�WINC ®� PR®P®SAD bE�
_� •� � lO cr6 �eo� �elo�r✓ o� s�c�? a site
drawPnq)
i; t..CP•� rent' must frill in cries P
devel©p
I t
DCM- MHD CITY
WAIVER SE6® L lift, or groin must be set
breakwater, boa house,
1 , ndars«nd that a Pier: dock, f orn pilings, rbelow.
ooring my area of riparian access unless w2ived by me- (�� You
b ck 2 rninirnum distance o� , p ria-4e blank ® I iV �®
,.te,^wive the setback, You 0�s initial the aPp P R
I do wish to waive the 15, setback requirement. FEB O S 2017
I de not wish to waive the 15' setback requirement_ a Lion)
(�dJacerit P
Gyqrer 1 orfedcatEOri)
` S"Lb11GLt7�%2 � C
d ANC print or7'ype 1V@me
-;��
JVarie
Mailing Address e
�ri Ssi►i
eono�e .N✓r»Gr
. V . Zal,
it
er
(Revised 6/93/2012)
ME:9 L[06 'lE ,u�r

i
fir, ��CE1�9 i RIPARIAN PROPF6 i Y OVUB+BER Sj�► i EIIIiEN s
i _ s
- sd acent to r �rrer)
T_ csrli that 1 own AroPe' J (Nara�e of P operhr
1 -q; reoy 5,
u Iocec,®ad, etc.j
p �pery located et (Address, 9-ot, 1�� GAe2[`7 N.C-
J (Gity/"I'own 2nmlor GP� ovtri
o'1
1 (►,i1r*aterbody)
below,
i le applicant has described to me: as shown
the development proposed at the above
\ clip
I have no objection to this proposal.
! rvossl.
I have objections to this p P
.�----
cSCRIP'6[Of� AND/®P DRAWING OF PROP®� below
e ow o,atiach a sjte drawing)
D n+e�af u7sust fit in des p
(irTOdivjdL1a! �O "�POS/nc de;ledoP
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k
r
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i
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e
F C>41;
rr
f. g
1i
f �d1iAlliER S�G'�'IOf�
boathouse, lift, or. roin must be sit
t., at pier, dock, mooring pilings, breakwater,rpg. (If you
ndersL�nd that i? p ,
minimum distance of 15 from my area of riparian e blank beloeZswaived by
a you crust initial the -appropriate RECEIVED
,.,d14zh.to waive the setback,
I do wish to waive the 15' setback requirement. FEB 0 $ 2017
I do r•ot wish to waive the 15' setback requirement.
Tele" phone Number
M�
z�ss Lt
(Revised 611812012)
E 'd ONZ 'ON WE: ClOZ 'IE 'u�r