Rucker, Alen

4'
MA / DREDGE & FILL.i�
8"69 A B D
I\ERL PERMIT Previous permit #
[few ❑Modification ❑ Complete Reissue ❑ Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resour s ommissio an area of environmental concern pursuant to 15A NCAC
� i!
-';; ule attached.
Applicant Name_ _ �" '' Project Location: County*
Address —To +°,r j Street Address/ State Road/ Lot #(s)
City ! el t: ` � � State/ ' ZIP � r.., A
Phone # 4(E-Mail °+ Subdivision
en r
Authorized Agent , F , ;A.. " City ;. s;,'a` : ` •' ZIP oei
Affected CVN ElkV
❑ ES ElPTs Phone # ( ) Riv Basin
❑ OEA HHF ❑ IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body &�� nar` man unkn
❑ PWS
Closest Maj. Wtr. Body
.3.
ORW.yes)/ no PNA yet/ no ;r
Type of Project/ Activity Y s
(Scale.°'' )
Pier (dock) length
�
Fixed PlatformI y
s) iu
Floating Platform(s) ! I
Finger piers) { . ..._...... .... ..... ......... .. ..-.- .......
Groin length
number
Bulkhead/ Riprap length .......... ... ..... ... .... . _...._.... .... _........ .... ..... .... .. _ ... ....... ......._ -°
avg distance offshore
max distance offshore j
Basin, channel
cubic yards
Boat ramp
,Boathouse/ Boatlift
Beach Bulldozing
Other

r
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:
EJ Tar - Pamlico River Basin Buffer Rules 0 Other:
El 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

uAMA / ❑ DREDGE & FILL
,
w� nw A B C D
1EIV ERAL PERMIT Previous,, permit #
mew ❑Modification ❑Complete Reissue ❑partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resour es ommission ' an areaof environmental concern pursuant to 15A NCAC
Rule attached.
Name Project Location:; County
f Street Address/ State Road/ Lot #(s)
d
State ZIP, 4M
E- ail Subdivision
ad Agent /t¢."° City ZIP
CW �rTA ❑ ES ❑ PTS Phone # ( ) Riv Basin
❑ OEA ❑'HHF ❑ IH ❑ UBA El N/A Adj. Wtr, Body - man unkn
El PWS:
no PNA y o Closest Maj. Wtr. Body
Project/ Activity Yr, Ci
lock) length
,ting Platforms)
er pier(s) '� I
in length
number
:head/ Riprap length — - -- ----
avg distance offshore
max distance offshore �—
n,channel
I
irApplicant Printed Name PermitOffic
"Please read compliancestateipent backofpermit Sig
10 —�tto�Fee(s): Check#: Issuirll Date
�6
(Scale: )
_..
no
F�r✓e

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:��T��
Mailing Address: `a/a ame1` / ral`l
oZ
Phone Number:
Email.Address: U n
I certify that I have authorized rru D(2'e-kel- �y„� •376j�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: LrAI w-w Ted
e V C a+ I'g 71 -a f 7.21 K if ' f' l� �� 1 �' 1—de,
at my property located at %i gha- 7-ra % , jCoier ld le , Vi C, ,
OF
in C-Ar+e o tt- County.
I furthermore certify that I 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:
17- Signatur
&aeke-r
Print or Type Name
to hm r
Title
M
Date
This certification is valid through I l
SEP 2 12016
®CM- IVYH® CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
*` I hereby certify that I own property adjacent to A. AA Ge.9ec 's
(Name of P operty Owner)
property located at '
(Address, -Lot, Block, :Road, etc.)
on Boor. e K , in , N.C.
(Waterbod Y) (City/Tow 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. . _.
FINE OF PROPOSED DEVELOPMENT:
fill in description below or attach a site drawing)
la 16 Tee
ZaQ1k'�aY
WAIVER SECTION
I understand tfat.a pier, dock, mooring pilings,.breakwater, boathouse, lift, or groin must be set
back. a minimum distance of I S'. from rriy area of riparian access unless waived by me. (If you .
wish to waive the setback, you must. initial the, appropriate blank below.)
v' 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)
Sgnqt4#e Signature.
1 AI&A ud esr J1` , W A-q of cp L e;F i1
Print or Type Name Print or Type Name
«t�jjer Tra; ! J z-1 0
Maffing Address Mailing Address
C- / tate/Z`ig Citrlswelzip
f 9 7 -31 919 -3.0 -aT6 g ► ' ��� y..
Teiepho e.�NuInber Telephone Number
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �'AtVu�.ot— 's
(Name of P perty Owner)
property located at !OA
(Address, Lot, Block, oad,
on 6OQke SD , in a , N.C.
(Waterbody) (CIty/Town ndior County)
The appli nt 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 develop iient must fiffin description below or attach a site drawing)
_s RECEIVE®
SEP 21 201E
. s.
WAIVER SECTION
I understand that. a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 16 from my<area of riparian access unless waived by me. (If you .
wish to wave .the setback; you must initial the. appropriate blank below.)
do wish to waive. the 15 setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner Informs#ion) (Adjacent Property Owner Information)
g
S Hato Signature
Print or Type Name Print or Type Name -J
,c _T',ger Tom;!
Mailing Address ' J , Mailing Adis
7 C�
Crty%Stafe%Zip CitylState/Zip
ys t
else Nu er Telephone`Number
�3 �l�d �:�`2 3 � �f 5b
Date Date $jJq
(Revised 611812012)