Reid, Fred

Authorized Agent r
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ORW: yes PNA yes (no,,)
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max distance offshore -
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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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules
❑ Neuse River Basin Buffer Rules
❑ Other:
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/ I-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

e,
lam' dSa�I
D
Ir .:
rU - -
i-
t r u , Certified Mail Fee $3. 30 0557
ru $ 06
M Extra Services & Fees (checx bac add tee a 6ata)
opy)
❑ Return Receipt (—Jc$ U -
ru ❑ Retum Receipt (electronic) $ - ilkl POStrtk7rk
r ❑ Certified Mail Restricted Delivery $ * (0-- Here
O�Adult Signature Required $�{ 0—
Adult Signature Restricted Delivery $
p Postage $0.47
r.% $ 10/i l /2016
Total Postage and �.� . 77
$ 1
.n To 19►' N _l2;
ri
e�R►t
NO feetanP�-�O-,
Lt-
rPOBoxoCS,ta4li .
2-- 1 &69
- -- ---
N:G
MOREHEAD CITY
3500 BRIDGES ST
MOREHEAD CITY
NC
28557-3095
3652240557
10/11/2016 [phone] 12:28 PM
--------------------------------------
Product Sale Final
Description Oty Price
First -Class 1 $0.47
Mail
Letter
(Domestic)
(RALEIGH, NC 27609)
(Weight:0 Lb 0.30 Oz)
(Expected Delivery Day)
(Thursday 10/13/2016)
Certified 1 $3.30
(®®USPS Certified Mail #)
(70161370000232246729)
Total ----- — $3.77
Debit Card Remit'd $3.77
(Card Name:Debit Card)
(Account #:XXXXXXXXXXXX9918)
(Approval 0:467686)
(Transaction #:512)
(Receipt #:002637)
(Debit Card Purchase:$3.77)
(Cash Back:$0.00)
Text your tracking number to 28777
(2USPS)- to get the latest status.
Standard Message and Data rates may
apply. You may also visit USPS.com
USPS Tracking or call-.1-800-222-1811. __

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Tz)d
Mailing Address: .1 b O A r 1 y 5:
I NC 14'.-,-to 11 N.C. 23512
Phone Number:
pr `
Email Address: 1�
I certify that I have authorized Up `3t jc 7
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: CW l M 5 _fly' r4
C7'�j "baLIQ
at my property located at _�o 0'�
in County.
I 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: RECEIVED
NOV 14 2016
Signature U - MHD CITY
Print or Type Name
t�LAJ" t-l-e-f' RECEIVED
Title
Z0 / j DEC 0 5 2016
Date DCM- MHD CITY
This certification is valid through I I

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
i hereby certify that I own property adjacent to 1 P 's
tt (Name of Property Owner)
property located at 0 A. �L Le7i - f r ) V u ,
QR (Address, Lot, Block, Road, etc.)
on - I J t��'�c� �.n.D , in P1 NC �N�» �''�gf'�-S , N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: ?D*e13- N.l B J9l' P e S Mailing Address: S a-7 P tso e- K k
Agent's phone #: z-' ZY' 1 -" 1 S 4+ m or eh,e ts �) C i-('v� (1i • � • �
-He/She-haszdescribedfo me as shown belowtrle-development he/sheds proposing at that location,
and I have no objections to the proposal.
----------------------------- ----------------------------------------------------------- ------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description ;below or attach a site drawing)
' .fir---- -�
o O ",
__ HIC-4(
T)oc):-
T-A--p) &ex (Rohr t Pt i Itiq<
if 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 notice. Contact infonnation for DCM offices is
available athttp://www.nctoastaimanagement.nettweb/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information) (Riparian Property Owner Information)
Signature Signature
`f l
Print or Type Name Print or Typb Name
Mailing Address Mailing Address
Pt t- E Vivo k� - i har,c5 N, 2'6-�j2 -& 0 N . Q . 9-26 ORECEIVED
City/State2ip City/StatelZ
ZSZ t='Z? -_ L4Z.(CJ 911- 71-j -o-It '5` DEC 0 5 2016
Telephone Number/Email Address Telephone Number/'E'-ma# Address
)a— 11-1 (3 Et) �, I —tom ®CAM- MHD CITY
Date 4 201� Date
NOV 1 (Revised: Aug. 2014)

ADJACENT RIPARIAN PROEM- OWNER STATEMENT
I hereby certify that I own. property adjacent.to
(NAF66 of Property Owner)
property located at 0, Q Dr I \J:T=l ,
(Addriess,.yt,BIocK Rdad, 6t6.)
on in)4t.-iho,­.
N.C.
(Waterbody)
-(City/Town andtor County)
The applicant has d scribed .. to e me, asshown below, 'the.development proposed at the above.
locati6fi.l
V - I have no objection to :this prop
osal.
I have objections to this proposal.
DESCRIPTIOD
(Individual,0roposing.d6i .
REC
EIVE®
J
T�l NOV 14 2016
�.J
DCM- MHD CITY J.
WAIVER SECTION
I understand that. apiO, dock, mooring pilings, - V66kw6f6r, boathouse, .lift, or groin must be get
irorh;%,at a of -:n anan access unless waived by me. (If you
PaQk:a Minimum distance 'of. 15 . " , ** ,
6 p J
a , 4 " 1 .-
wishtowai .the r
. waive Q you he appropriate blank below.)
I do wish to. waive. We 15'setba
ck requirement.
I do not wish to waive the 15'setback requirement.
4 i
on)
(Pro
Owner ion) (Adjacent Property Owner Infoftati T
Jm
sigh
Pr(,nF0orr_-T, ype Name Print or Type Name A.
Maffing Add,
Malling Address
14al e- 2.q5-1 7
RFECEIVED,
CitylStateMp CC
DEC 0 5 2016
Telephone_NOmbe Telephone umber
Date DaM ___DCM ® M H 0 C ITY.
(Revised 611812012)