Goatzinger, Ted

kcEDGE & FILL
EaL PERMIT Previous permit #
VNew ElModification E]Cornplete Reiss artiall Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
—1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
licant Name AppProject location: County
Addressn I tj rfri I'lStreet Address/ State Roz d/ Lot #(s)
City-L-1 I rK 7,- State 111�- ZIP Lc
:Phone # Fax # Subdivision
Authorized Agent city
, , �) C —V L ZIP
El CW
-qEW
PTA DES
0 PTS
Affected
AEC(s): DOEA
DHHF
EIIH El UBA
0 N/A
El PWS:
El FC:
ORW: yes -'n-0-
PNA yes Crit.Hab. yes &-Ro)
Type of Project/ Activity
Pier
I.tf
ing
Groi
Bul
Basi
Boat
Boat
Beac
Othq
Shor
S"-
Sand
MOR
i Pho
I
Wai�
Phone# River Basin
Adj. Wtr. Body v, r
(nat`.Ln-,,/unkn
Closest Maj. Wtr. Body
(scale:
s)-
'r pier(s)
NNUMMONEMENEEN=
length
mom
number
ead/ Riprap length
avg distance offshore
max distance offshore
-
,channel
cubic yards_
ramp
house/ Boatlift
� Bufldozing
i
r
WEENEENEEMENEUMMENNEMMMENMEW
-
[line
Lengt-h-■■■■■■■■■■■■■■■n■■■■■■■■■■■■■■■■■■■■i■'
not sure yes,
Dags: not sure yes �nq;
torium: n/a yes� ('n�'
s: yes,
mr.4-w6ecl.-
A building permit may be required by:
Notes/ Special Conditions i1 -A i
El See note on back regarding River Basin ryles.
n,
j'Agent or Applicant Printed Name
Permit Officer's Signature,
I Sign ktqrp Please read compliance statement on back of permit
lssuingD at
ExpiratlonQate f
J.
,i
Application Fee(s)
Check #'
Local Planningjurisdiction
Rover File Name

10 n
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 Citv Headauarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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

1.
Y + M
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ) 13
Name of Property Owner Applying for Permit:
�E mA,2�o,,j Goe4z �zr
Mailing Address:
I certify that I have authorized (agent) 0e,-ps, ko, -Trc to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) pa L VL •
at (my property located at) i -2�0 a P.6a^4 o c
This certification is valid thru (date)
A
Owner Signature
6 (, -
Date
�C'�IVED
a
PM-- HD MY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to ��.D -'s
(Name of Property Owner)
property located at ��a (a2bA�'LH� -
(Address, in Lot,PI��Road, etc.)
on C A N ►4� -, , N.C.
(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 must fill in description below or attach a site drawing)
)Zs tb sbF�-
p"5
RECEIVED
OCT 81 Z013
pCM-MftA CITY
WAIVER SECTION
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.)
V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
P`rint or Type Name
l � 0 r- '.a 4 a s-
��IK Is ddres C .
City/StatelZip
' z -) 1 -1'1b,.
Telephone Number
Date
(Adjacent Property Owner Information)
141 A" � 4 �
Signfit/atzf✓r
Print or Type Name
Mailing Addres
City/State/Zip
/VG 2�51
Te/ep one Number
02I % 2.l 3
Date
(Revised 6/1WO12)

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at 1 O A r hay ,_, .4 e e
(Address, Lot, Block, Road, etc.)
on y) , in PKS , N.C.
(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 must fill in description below or attach a site drawing)
RECEIVED
OCI 31 Z013
R Id
IZs IP
y.�S �vS �wALc_
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.)
�R I do wish to waive the 15' setback requirement.
(P
I do not wish to waive the 15' setback requirement.
on)
Print or Typpe Name
Ma�,g,Ad�lress N • L .
CityCity/Staterlip
Z,�����
Telephone Number
l0•lG./�
Date
Property Owner
S. tub �� T
Pri t or Typ me
ailing_ I � C —Z $� % Z
City/State%�ip
Te/ephon umber
Date
(Revised 611812012)

MUD BUCKET DREDGING INC 6627
507 HEDRICK BLVD
MOREHEAD CITY, NC 28557-3045
2 �.. k—66-112/531
Date--
Pay to tF' N C- D )ti 1Z__ I SP,
order of -ram iZoo (�
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