Paylor, Roland

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 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/ 1-888-4RCOAST
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.nccoastalmanagement.net/
Revised 08/27/ 14

LLAMA / El DREDGE & FILL1j
4
�+ GENERAL . PERMIT
A B..
Previous permit #
eW :.. ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
rthorized by the State of North Caroling Department of Environment and Natural Resources
- s"'3 J• y =' - --
he'Coastal Resoures"ommission in " area of ofiVironmental concern
iptiursuant to ISANgAC.#
#i
`T 1 ,✓V
f
Name
f
( �
ct .�ire� ll
les attache
rcant
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l
County
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e s , :
Street Address/ Sta
oad/ Lot #(s)
fi
State ZIR'rM r
x
a ` !
E-Mail
Subdivision
t r
orized Agent '�1 1,
city t€
�. ZIP;`_'s�
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❑ CW ❑ EW ❑ PTA *S ❑ PTS
ted
Phone # -Y.
IV River Basi-
❑ OEA ❑ HHF I] IH ❑ UBA ❑ N/A
(s):
Adj. Wtr. Body
} a- �crat :'man unkn
❑ PWS:
�.
yes / (no PNA yes rho
Closest Ma'. Wtr. Body Ltl k ) I ti _ --
w �.,
1 Y f
e of Project/ Activity
(Scale:~ 7 Z
r,(dock) length r

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
r
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA pe its
necessary for the following proposed development: __...6U1A ��_�Ct
at my property located at F" "V C
4 F W__ r'Ov -1 W �j
in—
1 furthermore certify that 1 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:
RECEIVE®
Signa e JAN 31 2017
Print or TypeNa DCM- MHD CITY
Title% RECEIVED
Date JA N 12 2017
®CM" MHD CITY
This certification is valid through J I

ADJAGEN T RIPARIAIt PROPER • O.VhVEiR STATEM'E
ma's . I hereby ce�rtif �� tat 1 ovvn prcperty adjacent. - � �.
of P.ro nerd
property Ioca0d < t e
on ,i ; . _, in N.0
atc�irbotty�y/Town Indio Unty)
The applicant ha � d )scdW to me,. as s own below, `the development proposcid at 10 'above.
f have no-p1* ft ion to.this .l iroposAl.
i h eve objeCtir, n .to fliis pt� �posL ..
DI S(:filPTi Na' �1KtM OF I�ROI�pOS9D..DWEL.OPMEN'T.
(lrtdiidual psi apc�sli lg.dave�'opiniif:riru st t'ilr in'descip.'lon below Or sftaclrts atrawingj
R . CEIVE®
`d J N 31 20.17
C),
. <.
.\ •I e ' '.�
At it 4
80 6TION. - 1
�� 11 understand iat: a lai r}-ddcl:, iYioori i s;: Sreakwafer, boathouse; Mi or r in rr st ba set
back. a i mt m iistEcpde o1� 16 f cttn=rri i area .of.Op*ran: ico* unless -Naived by r (If you .
=:
wish 1 he yet lack, -yo imt st_ Iriltis J the. apprp riate blank below.)... =.
RECEIVE®
. ,=- I fit) nns� �. tct v�isn� a the �1 �' set hack requiremen � ...
JAN• 1'2 2017..
o not wisRi f waive tfte 1 E' selback requirn:'irent
i
Pro, ` OVler Ini prtrt ion) ' . (Adjaa ur t Property aw n ' arrvnY CITY
eint or ame print br Type Name
:� i
_�� Mailing aw
A
T kphorie Number 7}evph i ur» r
Date %i7 f� r ti > :. - _ - vats
(ReWsec s/1 MM) ±

AI iJACaEN.T RIPARIAr l PROPERTY Q1;tiNR STATENlE
:.. ._�.,
hereby certil y tf-at i ow
n pri,iperty adjacE nt.#o
r (atiie Proper . ner) .
property loaat A <it _�! .. � .�
(A c Iress, to#,-
onQ. in 4°
G (N,`at�rbodyj I /Town AhcUbr:C urn
( �tY th
The ap - nt Ira.; ci scrib6d. io me,. as s:iowo below,`the development proposed at ie above.
objo:,tion to _this p ropos'o' . '
I Nive objeu~ io;ls to this prcposal. _
USCRIP7101V:�ND1f�RDRpV I La CiF pROF'P SI:D.DEVEL��PMEf;T;
-(Indi cfael pr i pc sir: g ale vet rpm is n u a fill�`in afescrilit on blow or a�`tach s she rrawingj
,.
J-
6.�YC .a
\ V
AUL
P� 0 tv,
111 Sra
ON
,.- .
understartdaEiut: a is r� dick, rCroorin '} ilir ;"gj. reakwafer, Ivathouse; , or groin -mu t be set y .
back. a rrminimur i diste !c°e Of- t 'from rri is rea of riparian .a.::cess unless waived key m( (If you .
wish #a ive .th s )tb idc; .}you must:Inl' fftho. appropriate, Hank below.)
d w sh. tQ vir�ive tits t 5'setb; Lek requirement. RECEIVED' -
d y!'fi )t i&h, io *aive:tfie t 5' :setback requirerr ent. JA N 1 2 2017 4.
(Pr . .: Owns �r 1Hit 71--i
on ' . .�(Adj pt Property Owner In qlt HD C I�'11' . :
. SE r2 ! Sl r
PM
- leyf
Pfinfior Tjcpe � +e � �► - P r T !perNarne
^ M. Address
C e Tt' ► CitylState � �, 'Z�S 3
Te/ephdne /1fumG. %r _. tiWl fi` - Nainb r
(Revksed 6, W20t2) ;

rO 1
aNc� �«�s
T o� 5oulj4
lo�V.ea, Al c
,(:zWor
Rolo, tod�
v�af �y
RECEIVED
JAN 12 2017
DCM- MHD C1