Collier, Joan

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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, 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 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.net/
Revised 08/27/ 14

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lding permit may a required by:
G`6�'TF"�'''`T
❑ See note on ck regarding River Basin rules.
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s/' ecial Conditions
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SA plicant Prime a
PermitOffic
rated Name..
Please read compance statement on backof permit
Signature
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Check# , ,
Issuing, , Ye,
Expi tio, , ate

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 'SO2 T . 0 0 (' 1 C4" C Co e r
Address of Property: 1-2_ 4A ar --Ts f a V)d , 1"
(Lot or Street #, Street or Road, City & County) 2
Agent's Name#:
/9/4t W&k, lgaww—
Mailing Address: AAX
93
Agent's phone#:
212-S-0Y -0737
&e-
ZSS6'7
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with,dimensions.° must be provided with this' letter.
X—.I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http.lAvww.nccoastalmanapement.net/web/cm/staff-listing orby calling 1-888-4RCOAST.:
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian acc�� I q�N v b me. (If
you wish to waive the setback, you must initial the appropriate blanks g o I [ EC E Iv E D
I do wish to waive the 15' setback requirement. FEB O 12017 NOV O 9 2016
I do not wish to waive the 15' setback requirem9C M - M H D COW-
_ M H D CITY
(Property Owner Information)�67yy,-'-PC
JI �, p�
/uL�tll..�
Sig a ure
Tlit -p. �� I ► P.tr
Print or Type Name
�(Ja bo6k5 Av,
Mailing Address
Qla,vn" NC a-76 Z 9
City/State/Zip
Telephone Number/Email Address
-:3- op 0 iev U l P.4 1hod•6uhn
Iv•1�3-i�
Date
Property Owner Information)
Print or TVDV Name
Mailing Address
City/State/' .
Telephone ne Number/EmaiPAddressf
i
(Revised Aug. 2014)

CERTIFIED MAIL --RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: © 0-*1 ok-r1 16 n a (J E • 06 11 t 1 JW
Address of Property: 1 T t erce L-a n g + V JU W T5 )' t N C
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
A& r- Ode.- Aa...%ke-
Mailing Address:
10y /off 93
Agent's phone #:
2S 2 T-oy - 0737
Aa^e o-,
G f_6/.C. 2 Lf-I ;2
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. &description or'drawing,'with dimensions must be provided with this letter.
.I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htta✓/www.nccoastaimanaaement.net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
;)-9 53 1
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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
I do wish to waive the 15' setback requirement. NOV 0 9- 2016
I do not wish to waive the 15' setback requirement. ®�'-'-�
DCM- MH
(Property Owner Information) R E E I`i! I
A Ruv�- I?.
B01201
S na ure 004't . �I
,�o I r err ®CND- M H D
Print or Type Name
gc)g, (6fo®ffs Avx-
Mailing Address
al 5Z 9
City/State/Zip -Sco j k " 0 , e
Telephone Number/Email Address
10. 1g• I(o
Nnnt or i ype Na e
y
Telephone Number/Email Address
D�
Date Date
(Revised Aug. 2014)

a AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: &--- t td &-iC
Mailing Address:
Ilan-kiev-s �1. 610 col !1,J C
Phone Number: R! q - 6D3-4g49
Email Address: donne e_ . co Ike r (2 us, COv�
Al tr n 1 yahoo, co e-v-) d. A//e-�1,
I certify that I have authorized A ta�
Agent / Contractor r..G Qy'wr-- ") a"�
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Cx4-e n a( e vl5,i h j ot® Gk
1Q0 4,d; -TrisIv-11 10KA &alt# and Ir-move e-vts >? deeA-k
lr " / WtIfee"
at my property located at M8 A 1° ne l_Lt.n e- 17�t e-Is Z 'I enyl �C
in &flk 44 Count . 01059%
Y
/ 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.
Property Owner Information:
a
Signature
&-fiald el'ic
Print or Type Name
A6�C;4� 11
tle
l� l 6 / d61
Date
This certification is valid through / *Z- / 3> / 14
RECEIVED
NOV 0 9` 2016
DCM- MHD CITY
RECEIVED
FEB 01 201?
ACM- MHD CITY -

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WATER
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Ai4kwJG / Co.
1pak6 \ o
r
Alan G. Bailey
PO Box 93, Morehead City, NC 28557
504-0737 9 726-5443
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® RECEIVED
o FEB 01 2017
°DCM- MHD CITY
I
RECEIVED
fl
Nov e 9 2016
0
DCM- MHD CITY