Scott, Charles

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ENER-AL" PERMIT
;Previous ermit# '
P"
ew . , Modification: ❑Complete Reissue El Partial Reissue
Date previous ermit issued -
As autho zed by the State ON Carolina, Department of Environment
and Natural Resources
and the Coastal RLc ommiss'on in.an area•of environm nt I concern pursuant o 15A NCAC
�
Applicant t '
Rules" ched•
'-County
Name,i ..r ..
Project Location:
Address A
Street Address/ State Road/ Lot #(s)
City ti 't ti' State: ZIP;°"
�j ; �.." x
^�
Phone # (( "� 'tMai
Subdivision
r'
Authorized Agent (_Al
City t
i:? "� �:�. ZIP 11"
❑ CW *W PTA ❑ ES ❑ PTS
Phone # (
"'"' iver Basin
Affected
s : ❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
AEC"
�
Adj. Wtr. Body
t ; '-J 4! hat ' an �unkn
❑ PVV
ORW: " yes / PNA
,-
• .�
Closest Maj. Wtr. Body a. }
Y
t /"•, V
Type of Project/ Activity •,.
(Scale:
Pier (dock) length o
Fixed Platform(s)' `"
Floating Platforni(s)
Finger piers
Groin length
number -• -r« "
Bulkhead/ Ripr"ap length
avg distance offshore
fir
max distance offshorew'�
'
Basin, channel
-
cubic yards
it
Boat ramp -,
Boathouse/ Boatlift;-- ^" "'"""""'"
Beach Bulldozing,,...•
'
Other /',
.� ) �
Shoreline Length
SAV: not sure yes o
+
'
r,.
Moratorium: n/a yes
-
-
-
-
--
7
Photos: yes o
`
WaiverAttached: -' yes) no
A building permit may be required by:,;:,
Note Local Pl
( anning Jurisdiction)
Notesli$pecial C ditions
J, *• r
fw :i
J
4
Y
• 4
1 9'
I°Age t o , phcant`Pri d : e ,
Signature ' Please read compliance statement on back of permit
�q rrra

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 ❑ 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Forehead 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

>.---�
x �.

K
a
NCDENR
North Carolina Department of.Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director .
Date /� 6
Applicant Name <:::�4 T IFJ �-c a 7' —
Mailing Address
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) Er i c C/ fts to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
at (location)
RECEIVED
NOV 2 8 2016
This certification is valid thru (date) / DC M- M H D CITY
Signature
400 Commerce Ave., Morehead City, NO 28557
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagement.net
An Equal Opportunity %Affirmative Action Employer
RECEIVED
NOV 17 2016
DCM- MHD CITY
One
North.Carolina
N494=11Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to r-)4�0ame
's
oOwner)
property located at _112 . cs w r,-r st-
(Address, Lot, 1 121.11300d, etc.
on icAda in N.C.
(Waterbody) (CityCl'own 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. _.
DESCRCPTIO?
(1hi1h iodat proposing del
111".21
PM41
4ND/OR DRAWING OF PROPOSED DEVELOPMENT:
lopr»ent must fill In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 4reakwater, boathouse, lift, or groin must(
back a minimum distance of 15'. from rriy; area of riparian access unless waived.
wish to waive .t setback, you must initial the. appropriate blank below.)""`
- v��2016 3
�� do wish .to waive. the 15' setback requirement. NO
I do not wish to waive the 16' setback requirement. pCM
(Property Owner Information) .'(Adjacent Property Owner Information)
3
Signature SiZr
tune .
JC 4 P�7,fPJt
Print or Type Name Print Type Name -RECEIVED
Mailing Address , Maili dress 'NOV 2 8 2016
City%State%Zp CitylState/Zip CX
TY
Telephone Number Te(ep ne " tuber
Date Date
(Revised 611812012)

J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
I
(Name of Property Owner)
property located at ��-
(Address, Lot, Block, Road, etc.)
on ,� , inC- .'.� , 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 a
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. v 11 ti016
(Property Owner Information)
Signature
Print or Type Name
Mail�g Address
Telephone Number
Date
(Adjacent Property Owner Informatiq�r�
Signature RECEIVED
Print.or Type Name
/Io ,Eowf�,V St NOV 2 8 2016 -
Mail'ng Address
City/S e ip
�- MHD CITY -
s 413 3,,3©
Teleph ne Number
Da
(Revised 611812012)