Manatee Investments (2)

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 I) 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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)
http://www.nccoastaimanagement.net/
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 - South of New River Inlet -
and Pender Counties)

AGENT AUTHORIZATION FORM
Date Ll
--aL -
JAIN U b LUIt
DCM- MHD CITY
Name of Property Oiwner Applying for Kermit:
44
Mailing Address:
ikc-
z--k, c .- cqz
I certify that I have authorized (agent) C,11 4 Atirr i � to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) e r-e l ,�Lno
1C CM G
at (my property located at) =1 Y411POA
This certification is valid thru {date};... y t
1/1
Pro Owner S natur?I
MCI
RECEIVED
FEB 2 0 2017
DCM- MHC CITY

r
CERTIFIED MAIL • RETURN RECEIPTR QUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: t ' t �/(� a ��.' i�... " �,�, y'� (,,i.e
Address of Property:
tj (Lot or Street #, Street or Road, City & County)
Agent's Name #: 1 t 1�Vf 1 Mailing Address: PO Ll�y
Agent's phone # '" `-OHM I , /6 A/C
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawinta with dlmansinns ` mi --zi F a :,r,,, .�r.�, i :.:;:� t►.;. ,:...
V I have no,objections to this proposal. I have objections to this proposal.
ff you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt Of this notici - Contact in
fgrmatign for DCM offices /s
available at htti�:llwww,nceoastalmanaoemen! nef&"bo m1stafff listfn-a or by calling 148�dRCOAST.
No response Is considered the same as no ob)ectlon' if -you have been nattffed by �c 1 A,r� l
...__
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 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
/I tlon) (Rip an Pro erty O_ er Information)
t 7,.� /
.Signatur Signart re
i
Ptiritar Type Name
Print or Type Name
Maifin§ Address��
M ling Address
Cify/S e1Zi •/ - ���� _�.._ r � (� �l��iJ�%'.'� /U � ('J USCj �
p Clty/Stal p t�
LA Own".) 1,
50
Telephone Number) E'mafl Add $s w Telephone Numberl Email Ad red ss Jj
Cony
'Date " U �� T �j Friy ? c` p 1 �7 RECEIVE
Date
(Revised Aug. 2014) FEB 2 0 2017
DCM- MHD CITY

ADJACENT RIPARi PROPERTY OWNER STATEMENT
-I herebyCertify -that[ own property M i y fY p party adjacent toa k ElR,'`) j ici71�
Property located at +0 f (l( O l / `"-," Me Property Owner)
(Address, ot, Bloc Road etc.
in ' - i C_ T_ N.C.
(Waterbody) (CityiTown 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
oov wolpf
WAIVER SECTION
1 understand that a pier, dock, mooing pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum_ distance of IS from my area of riparian access unless waived by
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
-�rpm! I do not wish to waive the 15' setback requirement.
(Property Owner Information) (A cant Pro Ow or Information)
suiure Si tare"'
J0144 Mc CrAAJ A#41g7 /�_F57M_LCJ11L I im 1T�3� Rrgti'6 f f I ie
4�n3 r Type Name Print or T Name _
Mailing,,xOt�nao + _�.� 106 #r 7-2c 4n-
Adc1 ss a A Tess
Citify/ taie/Zl � ` z g� Fr AI O A g �
Z g 7-- pIS9 3 - 83 i(y/Srat ►P
Daxon/l 0fli &I ym.411"Coln
Telephone Number/ email address Tolehone'Number /e it address —IF—
JGtM �� 2�17 .k?are+
*Valid for one calendar year after signature* (Revise��.014}
FEB 2 0 2017
DCM- MHD CITY

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Boatlift 2
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Note: % thru bolts
used at 4A 0 girders.:
5/8 thru bolts used at,
hogslats and 6x6s