Schmucker, Jeff & Ann

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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:
r Tar - Pamlico River Basin Buffer Rules KI 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 (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

!'_ > fa lr ' F
7
Applicant: C-�!
Date: p`
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance•total
includes any
anticipated
restoration or
tem 'm acts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amou
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge4 Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ 'Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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ovNCDENR
North ;Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date ,
Applicant Name
S'-L /-YA CA,
Mailing Address I �oc1 ) �� S <( LA-r\,
John E. Skvarla, Ili
Secretary
1 certify that I have authorized (agent) Be n-�- _�C-�6 L-�s to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
at (location)
jock r\/1Of" Cow- 7 C
This certification is v thru (date) Z7111
Signature
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement,net
An Equal Opportunity 1 Affirmative Action Employer
RECEIVED
APR Q 2�
DCM Y.HD CITY
Nne
orthCarohna
AR"tlmalllf

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify than I own property adjacent to
dNarna :cif Pr 'arty 0�� her)
property located at Ifs- ��✓Z'L
(Address, Lot, Block, Road, etca)
on �� — - -- _ in I.C.
(Waterbody) (Cfltyffown and/or Cduraty)
The applicant has described to me, as slt')'vvii holov,,, thx d vdopi'ne t proposed Lei the above
loc i n.
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)
,r
D
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/Aaive the 15' setback requirement.
(P
Print or Tyap Name
/l f s t. 114 � AwlW
Mai mg Address Ls a
City/State/Zip
2 , �3 q
Teleq one N ber
Date
nt P
Print or Type Name
infGrt ,ation)
svP�
2
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Mailing Address � �
City/State/Zip
Telephone Number
Date
"� ��(evised 611 12012)

MAR-11-2013 08:52A FROM:KENLY AUTOMOTIVE SUP 91984-3035 TO:17245932803
LIAR/08/Z013/FRI 08:55 FM Carboline FAX NO. 'IM-=-0u� L. UU1.
P.1/1
1&121A_CE&TRIRAFUANPR!90egaT.YRW�NE.R!SMIEME
I hereby certify that I own property adjacent to
,s
property !ocated at A T
(Address, Lot, 8 ockfto2d, e['CJ
on at�Abody} in
(CltylTot�n am11� County)
The appfiant has described to me, as shown balow, the development proposed at the above
locatio .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till In description below or attach a site drawing)
eeti
�101 x
WAA V_ER_ 3�CTION
l 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.)
Print
I do wish to waive the 15' setback requirement.
1 do not wish to waive the IV setback requirement.
0
(Adjacent
P'
vmyi va5i wavicn�.
2Los=
Telephone Jilu
� 11113 _
Data
(Rev/Sed 8/1&2012)

ADJACENT_ RIPARIAN PROPERTY OWNER 8TATE11J1Ei?l_r
I I ereby certify iha? I ufim property adjac vr:t to 's
11 arne :of Pr perty Owner)
property located at��? ��L� ✓.flTh h ✓,[%%_ __ - r A .� _ ----
(Addres s, Lot, Busch, Road., etc.) c
on �a L _ in _77 7—, IN].
(Waterbody) (Coty own andlor County)
The applicant has deescrib`d to mr:, as shown k')olovt, the Ur.'V;EJ ;pinei1. proposed, at the, above.
Iocati0
°� 1 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)
to �J
el
:No
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.
(P
Print or T pe Name
Mailing Address
��.�i�Gsrdwrr/ M 7
City/State/Zip
7Z(/ s-f3 Z �
Telep ne Number
2 / /z0/ 3
(Adjacent Property Owner Information)
Signat e
Print or Type Name
Mailing Address
City/State/ZiIp
Telephone Number
rVI
(Revised 611812012)

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