Payne, J. David

CAMA/ REDGE &FILL .�/
ENE L PERMIT Previous permit # A B D
P
MICNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As aut rod by the State of North Carolina, Department of Environment and Natural Resources t
and the Coastal Resources Commi ion in an area of environmental concern pursuant to I SA NCAC f ' O f?
i ules atta ed.
1 r; A �.' Project Location: County. Applicant Name ' t- ProI
Address I L
j Street Address/ State Road/ Lot (s) .� �..�, �' , � _ :
City if ° "1 J �y� rn 6n State+4 ZIP
t �
Phone #'' �+ "I tC, E-MaiSubdivision
Authorized Agent .4'- "Y' `t',,.��. City ': al d' ZIP a`
Affected ❑ CW )l EW '�PTA El ES ElPTS Phone # ) 1 River Basin g �� � . r` f e
AEC(s): ❑ OEA ElHHF ElIH ❑ UBA ❑ N/A Adj. Wtr. Body 1' ! �4 A' -�'t " ' /'I £ ' at`Gnan unkn
El PWA,
ORW: yes / PNA yes / ,o Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(el '-'
Groin length
( BIhead , bprap length
Wavg distance offshore,,-.
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing-- ^• "—
Other
4
Shoreline Length
SAV: not sure
yes
n
Moratorium: n/a
yes
ip,
Photos:
yes
�n;�),
Waiver Attached:
yes
� no r
A building permit may be required by:
( Note Local Plannin lurisdiciihn) r
Notes/ Special Conditions , yt
+
Agent or Applicant Printed Name
r•
Signature TTe55se read c?impliance statement on back
of permit
r
Application Feels)
Check #
i(❑,'L
(Scale: � --,� )
❑/See
note on back regarding River Basin rules.
t
'ermit0f icer's Printe Name
ignatt
ssumg Uate

V. q
In
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 andvoid.
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 [)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 0 Other:
0 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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
1367U.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
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)
http-://www.nccoastalmanagement.net/
Revised 08/27/ 14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to �1 S 's
(Nara of P operty Owner)
r E ... .::. i e_ ��./ _
on in
(Waterbody) (City/Town and or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSE® DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
RECEIVED RECEIVED
DEC 0 3 2015
DEC 04 2015
DCM- MHD CITY
DCM- MHD CITY
Re pl"e- G xis h'A /J•n) Kkta,Q �j'p��p� 7s
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lif
back a minimum distance of 15' from my area of riparian access unless
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.
N
(Property Owner Information) Adjacept Prep" er Information)
t
Print or
Maiiing Address
Cit tate/Zi'
/s11 7 9'
Tele.phJ�ne Nuber
I. /iiq //.i
Dat
IF

ADJACENT RIPARIAN PROPERTY 01i1•INER STATEMENT
Joy I hereby certify that. I own property adjacent to Z 1 v .� , � 's
if (a of� perty weer)
:_
(Address, Lot, Block, Road etc.)
on 411,3-we S10w4 , in N.C.
(Waterbody) (City/Town andl6r County)
The applicant has described to me, as shown below, the development proposed at the above
location,.
-- � I have no objection to this proposal.
l 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)
RECEIVED
DEC 0 3 2015
UUM- MHD CITY
7S RECEIVED
lot ffc Aeolp • DEC J 2015 <<
DCM- MHD CITY,'
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 w ' ed ou
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)
Vol E-.L� —/ 0 A
'gnat re
I ✓S
w{ « Print or Type Na
/,/ ; d t,
Mailing Address
CState/Zip
19 2?j --? l.()' d
Telephone Number
Da e , a
(Adjacent Property Owner Information)
Signature N c bo�-
Print or Type Name Siyhs
illg Addres
Cityl/:;tatem p
Telep one Yumber
YcL4o

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: I U s -
Mailing address:
Telephone Number: Cl l 9 °t'1l ?1 ��� • C'&//
I certify that I have authorized A sae W414 - % ,� oe Cco„rs/ (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at Sa ZA&2 '-7)A -1 ZJ6 i QZ/.� r
This certification is valid through ��'�, 3T� CP/ J` (date).
(Property Owner Information)
RECEIVED
Sig ature
DEC 032015
Print o Type Name DCM- MHD CITY
Title, co, owner or trustee for property
///"ZP L 4 r-
Date RECEIVED
97/ - 210—o DEC 04 2015
Telephone Number
%n'e? ?Z 4a7 DCM- MHD CITY
Email Address