Piner, Jim

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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 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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Ed 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-648 [)or the Wilmington
Regional Office (910-796-7215) for more information on howto comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters.
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I -888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
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)
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

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AMA / DREDGE &FILL
ENE L PERMIT Previous permit
ew ElModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
d by the State of North Carf� ll,ina, Department of Environment and Natural Resources
and the Coastal 1144 s Resources Commission Wan area of vironmental concern pursuant to I SA NCAC 4
Rules a d.
Y g Project Location: County
Ct7AI �C
Street dress/ Stge Roa Lot #(s) ;y
y /
r
Subdiv' io '
} w
Affected ❑ CW `Qw PTA ❑ es ❑ PTs Phone #
❑ OEA ❑ HHF L IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. B
El PWS: ❑ FC:
ORW: yes / no PNA yes no Crit,Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platforms) f
Finger pier(s)
Groin length
number"*
Bulkhead/ Riprap length
avg distance offshore
max distance offshore....,..
Basin, channel "'--�-
cubic yards *...�
Boat ramp *—....
Beach Bulldozing. \
Other
❑ See note on back regarding
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AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: ::I-jpn Pi t-)
Mailing address: G pc--� U L --,-Ip
4DPC LAN i c C� '3c- t( 1-4 C
Telephone Number: :2 S a., -. ({'j „5-.;. 4 ::�
I certify that I have authorized 115� L-) (-- ' QdeTIS 7:Sb�t5(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of bbc -4- f C t'f=T-
at my property located at aDp,Jt_< Ct,J-I>
This certification is valid through _ /-2,. / IS- (date).
(Property Owner Information)
Signature
Print or Type Name
Title, co, owner or trustee for property
q-
12 --
Date
- .2 Z v S
Telephone Number
Email Address
RECEIVED
MAY 15 2014
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �_ ( M ?)r&rzk. °s
(Name of Property Owner)
property located at o���$� u, �►,��%�
(Address, Lot, Block, Road etc.)
on , in $5-1- �itI – - . CHIP M12157 , N.C.
( aterbody) (Ci y Town a d/or County)
The appli ant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
I 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)
gi:5�' 1P%114XC+WD 0'6
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 tint
ture *
�l•m Pim
Print or Type Name or Type Name
b-'), kS .r2c,J:P
Mailing Address
R—TLAPS-6e, vc=� ek
cits t ��"47 - 5'P-16 �.
Telephone Number/email address
q / : is
Date
*Valid for one calendar year after signature*
Mailing Address
City/State/Zip
Telephone Number/ email address
Date *
(Revised Aug. 2094)
RECEIVED
MAY 1.5 )FIs
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _"SIM ) n429 is
(Marne of Property Owner)
property located at �► - ":bp) LS �y
(Address, Lot Block, Road, et .)
on ��A lJ t�(\1P► �G c -U %J t- , in e-3; 4. � , N. C.
(Waterbody) (City/Town ndlor C� ounty)
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 PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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 waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Pro ert Owner Infotion)
rmtV.
Signature tignature.
a
Print ore Na sets 'EOP
Mailing Address
,-mcN �1c.
CityyStateyZip
_�. a -S
Telephone Number
Date
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 6/18/2012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at
's
(Address, Lot, Block, Road, etc.)
on in N.C.
(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.
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)
WAIVER SECTION
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 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
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
W
r
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J toy, 1' i �� 's
(Name of Property Owner)
property located at ol�a''!3 7��1tS ��D
(Address, Lot, Block, Road, etc.)
on ("n Pe t� r c e. ,A�- in �TL;�HTIC, L�3�i 9ZA N.C.
(Waterbody) (City/Town a d/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
l� I have no objection to this proposal.
I 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)
Sic f'Ac+tEb
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 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)
S' nature
J1 TV., T, I-rr—r
Print or Type Name
Mailing Address
Ft r4 r l c VC -0
Cle
/Stat ipphone Number
Date
nt
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
.3•�t�ls
Date
Information)
(Revised 6/18/2012)

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