Hamrick , Marshall

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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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules K4 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax: [phone]
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
1252-946-6481
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _/i�/o a- 6 I / r t 1T 1 M r 1 G r 's
of Property Owner)
property located at
(Address, L t, Blo k, Road, a c.)
on U (� w , in P N.C.
(Wat ody) (Ci !Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca ' .
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)
p
eY I�t1(rl
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 b elfgW613
wish to w ive the setback, you must initial the appropriate blank below.)
uv� I do wish to waive the 15' setback requirement. JUL 2 4 2014
I do not wish to waive the 15' setback requirement. DCM-MHDCITy
(Property Owner Information) (Adjacent Prope ner Information)
�,x
S' ature � � tune
Tf G ,a.)s _ g��s
Print qr Ty a Name P ' or Type Name
P 1 S f V� n � IG19a +.o K (( FCI.. RA
M fling Ad ss t y� Matint, Address ls
CitylSlate/zin. City S telLip
Telephone Number Telephone Number
7_/n ` 1 �f %- �0 . i Y
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / r lats_(j, I � ri �a im r I r s
located at J CS-� 'is (N71of Property Owner)
property 2Z � VQ 1 Gt U � Vl l{(,f'
(Address, Lot, Block, Road, etc. _}.
on r� , in �u la r+ V�feV`�( , N.C.
LJ (Waterbody (CitylTown andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
IJ V ---�✓ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing develppment must fill in description below or attach a site drawing)
10
VXCM
,BD
I
�o
o '
JUL 112014
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must b p-t-
back a minimum distance of 15' from my area of riparian access unless waived by m{Ifo
wish to waive the setback, you must initial the appropriate blank below.)
JUL 2 4 2014
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. DCMMOCITYY
(Property Owner Information)
rd�'' Aal-�
Telephone Number
7 — Ze� -1�
Date
(Adjacent Property Owner Information)
ature
Print or Type Name L i ll�q�s
fL VZ,::�
Mailing Address
City/Stat I/ 1P
a! - '3- /242!E'_
Telephone Number
rl- -5-- 144
Date
(Revised 611812012)

ConnectGIS Feature Report
Page 1 of 1
CON"ECTVIS July
14,2
Printed Ju 014
WEB HOSTING See Below for Disclaimer
Parcels - Updated 02-20-2014
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The information displayed by this website is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and othe
public records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for verification o
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