Loftin, Glynn

X`CAMA / ❑ 'DRED.GE &` FILL
ram�'±±
as5 A. B D
V EN ERAL PERMIT..,
Previous permit #
New [:]Modification ❑Complete, Reissue ❑ Partial
Reissue ' Date; previous permit issued
As authorized by the State of North Carolina, Department of Environment
and Natural Resources
and the Coastal Resources Commission in an ar a of environmental concern pursuant to I SA NCAC
"
a
Applicant Name h�%
s attac ed.
Project Location: 'County C".."�r
Address
Street Address/ State Road/ Lot #(s)
City r rI +,rr State Ile ZIP
—s
Phone'# (� ) %"ty ' .`� E-Mail
Subdivision
Aub*horized Agent
City i "' e i n,ZIP PkO,
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # ( ) River Basin iC
Affected ❑ OEA ElHHF ElIH ❑ UBA El N/A
AEC(s):
C,11
Adj. Wtr. Body r p . /:1 n man unkn
❑ PWS:
ORW: yes] no PNA yes / no
,
Closest Maj. Win Body �} C
Type of project/ Activity
Pier(1
(Scale:(0 )
ini7 Platform(s)
..■0■■�:��ii■i■����■■■■■■o
i length
number
MEII®■■■■■■■'■I■Ii
r!
____..__.�._�.■.
■■■■....■.■■■■■■.rr■■...:::::.■■■■...■■■■
Pa Ftiprap.length
max distance■■■■■■.�:
channel
�r:...■::..■■■■■■■■■■■■C■■■■■■C■■C
■■■■I�r■�
t■■■■■■ra■��w■�a■■■■■■■■■■■■■■■■■
NUNN
cubic yards
ram
.��■■■a�■■■■■■■■■■■■■■■■■■■■1■■■■■■■■■■■■■■.
■ri■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
-
■�■■■■■■■■■err•■�•■■■■■■■■■■�■■■■��■■■■■■■
■■■■■■■■not
■■■■■■■■■■■■■�il:�■■■■■■■■■■■■■■■■
sure, yes .
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■mn■nl?,�■■■■
■■■■■■■■■■■■■■■■■■■■■■■■�`■■■■■iW�IWIIiYiIiIW■■■■
torium: n/,a yes no
rs: yes •CCCCCCC■CCCCCCCCCC�CCCCCC��CL�W��iYYC
:;r Attached: Yes .■■■■■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■■■■■■■.
A building permit may be required by: (Y (C`�+` ❑ See note on back regarding River'Basin rules.
Note Local Planning Jurisdiction)
Notes/ Special Conditions L^
4
r.•,
dv
cant inte Name
Agent or APP' Rermitoff e ' Prin Name
Sign re *'�'Pleasereadcomplia €statementonbackofpermit Signa re
.76
ApplicationFee(s) Check# Isu gDafe E irate nDate
o: , , ,.n'+,(i ,• 6}:,� a yn ',a, t, ,v2�'" ,a�1 r fa a orf �,'. aY .i .�'.,a .W

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 ❑ 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: [phone] Fax: [phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

--. 2 CANAA / ❑ DREDGE & FILL
J 01
A B D
ORAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date, previous permit issued
As aut y the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an ar a of environmental concern- pursuant -to 15A NC -AC.'
x
9!rRutes attached:
Applicant Named $''%44
Project Location: County
Address_ ;3 c%y_ °� Street Address/ State Road/ Lot #(s)
City —IC
- CY State " ZIP €; C
Phone # (i,- ) E-Mail Subdivision
Authorized Agent... City 41
.' 1 ZIP
ElCW ElEW ❑ PTA [IES ❑ PTS 1 Phone # ( ) River Basin 4; ile
Affcted
❑ QEA ❑. HHF ❑ I ❑ UBA ❑ N/A
..; H Adj. Wtr. Body o`�r� J( JS n man unkn
AE s •
OR�V:, yes ( no _ '.PNA yes / no Closest Maj. Wtr. Bod
TypeofProject/Act:niaty an I-)V ��'t ('4 i:'`
- (Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers) -
Groin length. - - --- - - - --------- - ---- - -- - - ----- --- --- --- - --- )
number
rM k �„ f.1
IQ11 Riprap length i
"" -Irvg distance offshore.
max distance offshore L
Basin, channel
cubic y
Boat ramp _
Beach
Other
ShoJrelinne.-L-e�n
5 not sure yes no
Moratorium: n/a yes no
%;Photos: yes no
,t
Waiver Attached: yes no
A building permit maberequired by;
( Note Local Planning Jurisdiction)
Notes/ Special Conditions'
ivy
1 /~
❑ See note on back regarding River Basin rules.
xate t:xpiration vate

S
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
-- I
-7
Date 4-4
`
Name of Property Owner Applying for Permit:
(A,)'
. C r- L4 iV �) 1, n I i
Mailing Address:
O(Eo �
I certify that I have authorized (agent) �'�� �to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) �-
at (my property located at)
This certification is valid thru (
Owner Signature
i�
W9C-L,
Date
RECEIVED
MAR 16 2017
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
p (am of Pr perry er
property located at t p � V - �—`� IP
on V v k �L° 04 - ky�4 �ess, Lot, I3 k, Rin oad, etch) __ (-xo-- N.C.
fflaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc tion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fillin description below or attach a site drawing)
C19 VL, wu-P/
RECEIVED
MAR 16 Z017
WAIVER SECTION ®CM" MH® CITY
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information)
,Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone Number/email address
Date
*Valid for one calendar year after signature*
Information)
kf44C�1'UV'SG"-
I y ► ' E, R.-,G6V-iZ )ff --'- e-
M i ing Add1ss /t/ C c nn .
City/Statelzip
2s Z— � 3�-
Telephone Number/email address
3/I'O/77
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY/ OWNER STATEMENT
LC/
I hereby certify that I own property adjacent to V "� fv'� /'WW0-Js
is ! lRl�ra�n 9�rnola�! iiWYW7�
property located at / / !o (----z-V- -/
Ac A
�{Address
n t. � 1� _, in
{Waterbody)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual Proposing development must rill in description .below or attach a site drawing)
(l1/�Sl
RECEIVED
MAR 16 2017
DCM® MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
Signature
Signature" y
Print or Type Name
Print or Type Name J
Co.,
/ 7-3 >ti S
Mailing Address
Mailing Address
City/statellip
City/ t 0P
S�z- W7- n 3 70
Telephone Number/email address
Telephone Number/email address
03)0 V/ z
Date
Date`
(Revised Aug. 20M)
*Valid for one calendar year after signature*