Ennis, Shirley M.

0A
tDCAMA E1,DREDGE & FILL J
GENERAL PERMIT Previous permit #
EINew '* ElModification El Complete Reissue El Partial Reissue Date previous permit issued
I., - As authorized by the State of North Carolina, Department of Environment and Natural Resources
1 �-71 C10
and the Coastal Resources Commission in an area of environmental concern pursuant to i 5A NCAC V
ocl- El Rules attached.
County
roject/Location: Coun
P Applicant Na ... "J-'VLA
Address Street Address/ State, Road/ Lot #(s)
pty State i ZIP--- ,
Phone #((J,P) V Fax#(—) Subdivision
uthorized Agent xt,-L City ZIP
0 CW hiEW I "9JES 0 PTS Phone # (-11q) -�7S )-I —6(,-Qt1 River Basin
Affected '�PTA
AEC(s): El OEA 0 HHF El lH 0 USA 0 N/A Adj. Wtr. Bod -"i Lv-
0 PWS: 0 FQ Y, � -, ) I I - (nat
/ I Closest Maj. Wtr. Body 'J I
01RW: yes / no PNA yes / I? Crit.Hab. yes no
i-;I
[Typeof Project/ Activity ,% k k
V
(Scale:
Pier
ier (dock
Platf
Fingi
Groi
Bulk
Basii
Bow
Bow
Bea<
Othi
Shot
SAV
Sanc
Mor
Phoi
Mail
r pier(s)
length
number
�n�■■■■is
iead/ Riprap length
avg distance offshore —
MOMINMEMENEEM
MMEMEMMEM
No
EMMM■■■
max distance offshore �J'
channel
cubic yards'
ramp
-iouse/Boatliff'
Bulldozing
,-I
r
fline Length IJ
MEMO
EMMOSSNUM■OMMEM
u■■■■■■■■■■■■■■■■■
not sur e , yes (n�
-
wags not sure yes (r�o
torluml: n/a yes
yes oOMEMEMEEMMEEMEM■NEMENNNOM■MEMENNEMEMEEMEM
tr Attached: yes "no
L 11 A building permit may be required by: /,--) El See note on back regarding River Basin rules.
Notes/ Special Conditions V( il I
. .......... .. - ----- I
Agent or Applicant Printed Name Permit Officer's Signature
Ilk,
Signature "Please read compliance statement on back of permit" 'Expirati6n Date
o
4
Application Fee(s) Check# Local Planning Jurisdiction Rover File Name

a
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 ❑ 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 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/ I-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

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
['hereby certify that.I own property adjacent to �E �� t J' -'s
„ . _ -1-057 (Nama of property Owner)
property located at ./ ..... cA-
- (Addr ss
on ��AAJ`t. f' in
(Waterbody)
' (City/Town and/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 roust fill in description below or attach a site drawing)
u i l N r w I/ % N ,�E� a� a ff
Ild
O SF1f W Ct
RECEIVED
OCT 13 201A
DCM-MHD CITY
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
I do wish to waive the 15' setback requirement. OCT 15 2014
I do not. wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner Information)
Signature
S
Print r T Name
.. Date...
(Adjacent Property Owner Information)
Sign ure
�yl,a g;�g
Print or Type Name
q oo ScA00 pf-
Mailing Address
Lk); IL i aM sIo.j AZ a IN 0,
City/Stator
Telephone Number 1
_Date..
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I 'hereby certify that. I own property adjacent to e1'41'lrI I's
(Name of Pr perty Owner)
property located at V,'ErJ....�r., _
(Address, ot, Blo•c,ad, etc.)
on �� % in �f ��fi �'c ��i1<c-� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatign.
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)
RECEIVED
OCT 13 1014
DCM-MHD CITY
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
AlIx I do wish to waive the 15' setback requirement. OCT 1 15 1014
1 do not wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State2ip
Telephone Number
Date
('Adjacent Property Owner Information)
Signature
Print o� r Type Name
Mailing ddr�ss
City/ tate2ip-;,J-6 / �--
Telephone�NuTber�/ �
Date
(Revised 611812012)

Styron, Heather M.
From: Jasa Ellis <[e-mail]>
Sent: Sunday, October 12, 2014 7:13 AM
To: Styron, Heather M.
Subject: Fwd: Permission to obtain a permit on your behalf 217 Bayview AB NC
Begin forwarded message:
From: "S.J. Ennis" <[e-mail]>
Date: September 30, 2014 4:27:19 PM EDT
To: "'Jasa Ellis"' <[e-mail]>
Subject: RE: Permission to obtain a permit on your behalf
This is to confirm you have permission to obtain a CAMA permit on my behalf.
Thanks,
Shirley (Sammy) M. Ennis
-----Original Message
From: Jasa Ellis [mail to: [e-mail]
Sent: Monday, September 29, 2014 10:49 AM
To: [e-mail]
Subject: Permission to obtain a permit on your behalf
Hey Mrs. Ennis, If you would respond to this saying that I have permission
to obtain a CAMA permit on your behalf, I certainly would appreciate it.
Thanks ,Eric
Eric Ellis
205 Nottingham Lane.
Morehead City NC 28557 RECEIVED
NC License # 66858= OCT 1.5 2014
DCM-MHD CITY

205 Nottingham Lane
Eric Ellis
Marine Construction
DOCKS • SEAWALLS -BOAT LIFTS
DECKS & REPAIRS
Phone & Fax: [phone]
Cell: 252.342.6775
Morehead City, NC 28557
RECEIVED
OCT 13 2014
DCM-MHD CITY
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