Carpenter, Mark & Shelia

C� AMA / L36111EDGE & FILL CA&A
P' 4 Ey ij�;fGENERAL
B °
PERMIT Previous permit#
``c ,'
Oew❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources I- f ' I
} I J
t; `(
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ! I
PqRules attached.
Applicant Name , t , ` _ Project Location: County £' i ,
Address ? Street Address/ State Road/ Lot #(s)
City t'1 v State ZIP.
y
Phone # E-Mail T t Subdivision" r.
Authorized Agent .. ( k. 4 City I'�,ir.. ZIP
❑ CW/ ❑ EW ❑ PTA \�,ES ❑ PTS Phone # '(' River Basin;
Affected
- ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A i i"f r i ' e-
AEC(s): Adj. Wtr. Body` ' ( : , � / 1 ! � 4,
nat /man /unkn
( )
❑ j Closest Maj. Wtr. Body
ORW: yes /(no PNA yes ro f
Type of Project/ Activity
(Scale:
j )
f
'
Pier
Fix
Float
Fing
Groi
Bul'
Basir
Boat
Boat
Beac
Othr
Shor
SAV
Mor
Phoi
Wain
■
NONE
In
��iiu�
'�■
max distance offshore �n I
iiwin
o�
I
rd
.
MENNEN
cubic yards-
ramp
ME
MIMMOMIN
No
IMMEME
JONI
=l■
dine Len,,h
no
MEN
IffNfM
EN
notsure yes
w■e
A building permit may be required by:
( Note Local Planning Jurisdiction) f {
Notes/ Special Conditions
"Agent orApplicant Printed Name t
Sig_Vt pre * j'lease repel compliance statement on back of permit
❑ See note on back regarding River Basin/rules.
Permit Officers Printed 6fa
Signature
Application Fee(s) k, Check # Issuing ate Exp ration Date

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, certifythatthis project is consistentwith 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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.nccoastalmanagement. net/
Revised 08/27/14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to CKY9 e✓ 's
(Name of Property Owner)
property located at I Wr1 fYoy\'t
(Address, Lot, Block, Roa etc.)
in V
(Waterbody) (City/Town and/or County)
The applicant has described to, me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
AV
RECEIVED
JUN 2 4 1015
WAIVER 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.)
do wish to waive the 15' setback requirement. RECEIVED
do notwish to waive the 15' setback requirement. JUL 13 1015
(Property Owner Information) (Adjacent Property Owner Information)
Signature • Signat�rey ' n his RECEIVED
Print or Type Name Punt or e�me `•G JUL 13.1015
--� T
Mailing Address Maffirg.,Addres y
City/StatelZip City/St e i
Telephone Number Telephone umber /
Date ^ Date
(Revised 611812012)

ADJACENTRIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that -I own property adjacent to �tG Sll� la C'>�e�,CAI 's
� (Name of Property Owner)
property located at lvxvt
(Address, Lot, Block, Roa�etc.)
on 'fl'L,410(� .+��2K in && � N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
IDca `p
have no objection to this proposal,
-I have objections to this proposal.
DESCRIRTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development' must fill in description below or attach a site drawing)
p( -}�1�e v t-�Pasa,�s owtd i r� a se -watt
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. �d� ��' On blehd;ng all—land-1-re�.nSi-ItnnS
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�n 'DE'►AILS '?O '-C—MpfJN As. o1z%(ANA1.LYVzA'WF3 Akm TrtoVmvtoN
'ALL t7TH�.Q
A'PR t L 141 2 O I S' &nd c'aait Seal kp r 4 I 2q, 20 IS.
! WAIVER 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.) RECEIVED RECEIVED
do wish to waive the 15' setback requirement. JUL 1$1015 JUN 2 4 1015
do not wish to waive the 15' setback requirement. ocnn_nnHo c1r;1
.(Property Owner Information) (Adjace t roperty� Owner Information)
Signature Sign, r ,, 11
2T W EI55 CltoCtl Fft)JT �:�
Print or Type Name Print or Type Name
I S 8q !Fog PILL C?..
Mailing Address Mailing Address
. : �o►t��rsvi����c. 2RSSo
City/state/Zip Cityl. rp
413�h�E8-
Telephone Number Telephone umper
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D t Date
as
(Revised 611812012)

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