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As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an afea of environr/nental concern pursuant to 15A NCAC
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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, 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 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/ 1-888-411COAST
252-946-6481
Fax: 252-247-3330
Fax: 252-948-0478
(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: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14
Type of Project/ Activity
(Scale:
Fixed Pla
Floating Platform(s)
Finger pier(s)��:CC'■CC��"CCC�CCC'■'C°CCCC■■=�®CCCCC
Groin length
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N I ote.s/ Special Conditions,, 4(le"t-4, 411242a
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01/11/2017 11:06 FAX 252 393 6341 L B PAGE LANDSCAPING
Page bandmapiugint,
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252-393-7766
Fax# 252-393-6341
FAX COVER
DATE: � L11
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TO:
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FROM ob:
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# of pages 4— (including g cover)
COMMENTS.
Q001
RECEIVED
JAN 12 2017
DCM- MHD CITY
01/11/2017 11:06 FAX 252 393 6341
L B PAGE LANDSCAPING
Q 002
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ECEIVED
AN 12 2017
DCM- HD CITY
01/11/2017 11:07 FAX 252 393 6341 L B PAGE LANDSCAPING Q 003
pa
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ed
I hereby certify that I own property adjacent to
property located at 4/ 7 t o d I H Wd
Address,
on SI A eg •in-
(WAterbody)
Property
(City1Town andlor County)
I
KC.
The applicant has described to me, as shown below, the development proposed at the above
location. � JAo
►/ 1 have no objection to this proposal. ' ^�
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I have objections to this proposed.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
( dua#,P 1ng.: :mu,n llll M won tietow o►.affedr•a sJ% draw/n )
..'e-'
y} a Go r '�� RECEIVED
?� J JAN 12 2017
` w$ sE--CT1ONjl H D CITY
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse,
must be set back a minimum distance of 16 from my area of riparian access Unless waived byt
me. (if you wish to waive the setback, you must initial the appropriate )
�19SV I do wish to waive the 95' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
".n_/-L__
i
Tehwtwm Number/email address
Date
Cafrs
"Valid for one calendar year after signature`
(Adjacent Property Owner Information) I`i I ,r
signature * ALL
Ptint or ype Name
, Aad►ess
/stare/zlp 4 _ *3 56
c,ta.1.3,9C> ..
Telephone Number / emat7 ed Iss �j %►�► CL� L . C O 1"r1
a-Q— .2
Dale" --
(ReWsed Aug. 2014) )
1
01/11/2017 11:07 FAX 252 393 6341 L B PAGE LANDSCAPING Z 004
ADJACENT RIPARIAN PROPERTY OM U K&UMM
I hereby certify that l owr► property 808CWA 10 10 A1J To I tR 114 b% s
�( aI Prgwrby owner)
property located at �I I J Meaan ttj ✓t!w Ic
(Address. Lot,�Rock, RoaaRc) `
on s iai l._rA it IL in (G.,.��I, jay. Cs w T � ^� N.C.
Ar lI) (CltyRawn anWo► Count)
The applicant has described to me• as shown below. the development proposed at the above
location.
• I have no objec* mt to this proposal.
I -have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(haVvidual ProPoeO dbw&%Vmwd awst fiN in descrilook • setoor atilach a sft drowkW
LD
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�: I} eel fe
RECEIVED
JAN 12 2017
DCM- MHD CITY
WAIVER SECT 1
f understand Ihat a pier, dock. mooring pilings. boat ramp. breakwater. boallwuse, lift. or groin
must be set back a mmimmn rn distance d IF from my area of riparian access unless waived by
me. (if you wish to waive the setback, you must Initial the appropdale blank below.)
✓ I do wish to waive the I & setback requirement.
I do not wish to waive the IF setback requirement
( dI► I ) (Adj.a.nt Property Ow"er In>brmatlon)
I t
Teiephan Number /ems# address
i........._.
Mir
c U Zt V416
Teiephone�Nfuff bar / emad address
(Revrsed•Aug. 2014)
'Vabd ror one calendar year after swa uW
01/16/2017 09:57 FAX 252 393 6341
L B PAGE LANDSCAPING
C =
.
252-393-7766
Fax# 252-393-6341
FAX COVER
DATE: / / Ftj/I
A /
# of pages (including / udin ( g cover)
COMMENTS: P40-Yul-4 7�
Q001
o9Y7 33 3 0
01/16/2017 09:57 FAX 252 393 6341 L B PAGE LANDSCAPING Q 002
1
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: D/'ra w x kos lK d v
Mailing Address: al 9 "O.011e-1 00,
Phone Number:
Email Address: Goag
I certify that I have authorized /July
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in c-a r4p r County.
1 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:
Signatu /
" -
Print or Type Name
(I,) co 48/-"
Title
I // i doll
Date
This certification is valid through / I so I���