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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 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 how to 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/ 1-888ARCOAST
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

AMA / ❑DREDGE &FILL
NE L PERMIT : a _ A B �,t p
Previous permit #
ew. ❑Modification ❑Complete Reissue El Partial. Reissue Date previous per it issued
i4h-a zed brthe-State of North Carottna, Department of Environment and" Natunf, Resauroeg — `- W,y�k
the Coastal Resources Commission in an area of environment I 'fncerq.pursuant to 15A NCAC j . �'
/ ules attache '
hcant Nare '' 11 y .. �y .:
Project Location: County. { �;. r
ress f% ,f' r" "i Street Ad rye t State Road/ Lot #(s) i
State ; ZIP }/ f '`, t
fA
-Mail '^ '" Subdivision
_ r ", v,- I ._ r
ted CW DEW ❑ PTA lS ❑ PTS
❑ OEA ❑-HHF ❑ IH ❑ UBA ❑ N/A
PWS:
es no PNA yes /
pe of Project/ Activity
er. (clock) length ^ "'
zed Platform(s)
oating.Platform(s) " ^�
ngerpier(s) -�
roin .length
Bulked Itprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards^'""
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing '•�--°'"""
Other
yy
Shoreline Length C 1
SAV: not sure yes 6w
Moratorium: n/a yes
Photos: yes
Waiver Attached.. yes to
A building permit may be required by:
(Note Local Planning Jurisdiction) r
S
n.i E 1 ..
City zip_
fir- 1
Phone # fiver B in
Adj. Wtr. Body
Closest Maj. Win Body "- �
❑ See note on back regarding Riygr Basin rules.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ) U'E-� ' 1'�6*0
Mailing Address: RO T'�bL :--OnD Loll --SG
e
Phone Number:
Email Address:
I certify that I have authorize(
Hgeni i Loontractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: a�0uncl '-
at my property located at 1 I (V �� C
in C�� County.
I furthermore certify that l 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:
!J ignature
& ,
Vp
Print or Type Name
Title
1 —/ / /7
Date
This certification is valid through 3 l—./_/ l
'0Q
do, do\I
MAR 0 3 2017
®CM- MHD CITY

�_jo;oefad6o99jo89o04EtiZ9S 6/xoqu!#/0/n/I!ew/woo•916006•1!ew//:sduy
hereby cerfKjt that I own propertY
f property located at
on
,iddress, LoT j . N.C.
The applicant has described to me. as shown below, the development proposed at the above
I have no objec tlon to tfds proposal.
I nave objections to this proposal.
CA o (rlolu uwca OF PRo�'GEVELOPMENT
' .r» Now, aieierolpt d below. orattacn a'#fte d awltiyj
Te�phar�a Nam / J ean� r�s.�"nkr
vim+
''VaAd for one year, altelr ' .
df
T�.
9
6df• �00 woo; eweo 9u9nud 9!!nf
r
3tho , , ik or groin
ss uns waived by
FAR
(Revised Aug. 2014)RECEIVED
MAR 0 3 2017
�NJ- �!�®CITY
FE8 % 11011
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M
l=aojoefoad1.oa9bo8ao0q£tiZ99 6/Xoqu!#/0/n/I!ew/woo•ai6006•I!ew//:sdl4y
I hereby certify that I own popeFiy a c'a a to
�►' Owner).
property located at l t9 (,.ag,o� P 'd
Lot -
on I=.1"'� UressN.C.
(Watecbody) (City/Town and/or County)
The applicant has described tD me, as shown below, the development proposed at the above
location.
Q / I have no objection to this proposal
I have objections to this proposal.
(IP DESCRIPTION ANDIOR DRIAII�INQ OF PROPOSED DEVELQPINENT ,
j•� (l�ld ildl rl j t+oAos�t 8 in* * f d piForil below. orattach a site divwft
��
I wAIM S jyMON
I understanc( at a pielr, dock, mooring pilings, bodUamp, braes
%r must be set Abet do a minimum distance of IV from,My area of rij
Q me. (if you h to waive the setback, you must Initial the appra
I do wish to waive the IF setback requirement.
I do not wish to waive the I & setback requirement.
(ftperty owner Info anatton) (Adjacent PI
kwater, boath lift, or groin
mrian accas, un $.waived by
Q�d✓ �eVIMd Afa 2014)
Fie c\'N#EcEIVED
IT
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