Collins, Thomas & Jennifer

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A building permit may be required by:
No es/ Special Conditions Ch:'
o
i
r ��lr� "fir-�i.'•l� �-' l�i"��i:}�% i � � t`•�'\
❑ See note on back regarding River Basin rules r
--t' � �• (" (f �' �'`rf �. �- ( if jjr: s, /, f'..,1 ,,�; fit• j;
r i r
Agent or Applicant Printed Name
Permit Officer's Signature
cs
Signature Ple se read compliance statement on back of permit'"`
IssuingPafe I
IExpiration Date .
in
Application Fee(s)
6ec'k#1
Local Planning Junsdiction
Rover File Name

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:
F Tar- Pamlico River Basin Buffer Rules Other:
El 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:[phone]
Morehead City Headquarters
400'Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(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:[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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

GP Habitat Sheet
Name: Thomas and Jennifer Collins Permit M 64119C
Date: 7/24/14
Address: 515 Neptune Dr.
Habitat
SF of Disturbance
SF of Disturbance
LF of Disturbance
LF of Disturbance
Shallow bottom
800
800
N/A
N/A
JUL 2 8 2014
DCMMxncffy

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
r ,p� (Name of Property Owner)
property -located at "S Iy L7VIe-
(Address, Lot, Bloc Road, et .)
on—tv,¢.r Cr es� , in C N.C.
(Waterbody) (City/Town an/or County)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal._
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
r n
'
fZ p4_w 2 " ' JUL 2
2014
—u� ' �.
'Zo, yam, 5e.�,Wa(1
�.i r r
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 waive$P (lf you
wish to waive the setback, you must initial the appropriate blank below.) 1,
I do wish to waive the 15' setback requirement. JUL 2 8 2014
I do not wish to waive the 15' setback requirement. DCMMHDCTfY
(Pr erty Own r Infor ation) (Adjacent Property Owner Infgrmation)
S ture I �(C ffi� c L Signature
AnV;Z L 'Loll L L<: WC
Print or Type Name Print or Tye Nam
/ % e
c��� /l/�vdv� Df2
MMail y Addre$� Mailing Address
11!!�ylU;!! P k) e, 64/t-7 0142fc;2e 7 NC 29SPY'
Cityqla-
afe2ip City/Staf ip
S-?6
Telephone Number t Telephone Number
7 2-1—
Date Date
1 _ p 09 (Revised 611812012)

Pat McCrory
Governor
Date � C>
Applicant Name
Mailing Address
TV
NWERR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Braxton C. Davis
Director
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) I MD �"'6uoact on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
at (location)
This certifi
Signature
cO- gel
ac
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
REEVED
JUL 2 S 2014
DCV �T. D CITY

• ADJACENT>'RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tom 's
Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on �1�('re ,in C ,N.C.
(Waterbody) (City/Town sand/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
-2 t1LLO'
JUL 2 8 2014
/`
515 MCS i-/Tkwrps lev,n Co
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.)
,REl�E1VEp
I do wish to waive the 15' setback 'requirement.��
I do not wish to waive the 15' setback requirement. JUL 21 2014
(P erty Owner Information) (Adjacent Property Owner Infp #Mr1)*
n ture Signature '
' /�/ LTdf✓ le L
P�qt Or Typg Name Print or Type Nam
FJ C/� 5//�=7�Tus,.� �z
Mail'n A g dress Mailing Address
G'y I I a. N C, 2RS��o C E �� �T�Rc y
Cit S e�z►p City/State2i
Telephone Number Telephone Number
Date 1 Date
(Revised 611812012)