Shigley, Hal

(scale: I )
I
AIR
111
11101130
M
Bill
ommoommMeIN
4,
f
1Sm
Imm
MEMINMEMMEME
Him010801
WEEMENNEEME
0
ious Boatlift.
..III
MOMEMPNIUMIFAM
MEN
momimmmmmmmmm=
1-1
1
1111111111r.1110
1BU111dozinX
MEMEN
IMMEMIMMOMMIN
11101
1111MINIM
MEN
INNNNNEROM
mmmmommom
MEMO
IMMEMMEMMEMEMMEMEM
mmmmommigne
mmii:11,
IN
mmmmoommosomm
IN
0
No
1011INMEMME
0
MENEM

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 .I) 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 El 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 howto complywith 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.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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)

L
(Appieu.' I (Ai L'icqpated lir;aj (Applied for, (Anticipated flf i a 1
Disturbance total d
Habitat i'lame 0 1 S TUR -3 T Y P E disturbance. ist Disturbance disturbance.
Choose Cra includes anyExcludes an%/ total includes Excludes any
antcipated restoration' any anticipated restoration and/or
restoration or andlor tamp I restcrat;cn or tern p impact
Dredge El Fill [] Both ❑ Other
Dredge [I Fill El Both [I Other
DredgeEj HIE] Both E] Other E]
Dredge [:1 Fill El Both [I Other 0
Dredge El Fill [I Both [:1 Other El
Dredge El Fill ❑ Both El Other [j
Dredge n Fill F1 Both El Other El
Dredge 0 Fill EI Both El Other 0
Dredge [I Fill [3 Both 0 Other rl
Dredge El Fill [I Both El Other El
Dredge [I Fill El Both C1 Other C]
Dredge 0 Fill [I Both El Other El
Dredge •Fill C Both [I Other El
Dredge E] Fill [] Both E] Other ❑
Dredge El Fill Ej Both []. Other El
k

A;�;�
N DENR
Nolth (1 iolina f iopartment )f Environment : nd Natural Rlesources
r ; ivision of t;oastal Manaf ment
Beverly Eaves Perdue, Goner. i 3r
,James i I, Gregson, Direc l Ii I:)ae Freeman, Secretary
Date J)71
PP :s-
1Vlaili>�g Addre,4.s _ � . -�2 _7609
_- - -- -
asAQ � K CAI-; II,/e
:_
;[ certify that I >have;tuthorl zed (agent) .�.a�.. �!�.� to act on ntY
behallf, for the put.i� :,se of a 3plying forand obtaining f 1. CAMA. Pei-mits necessary to112
install or construct. ;activit")
at (la�cetion) � `�
date)
This 116ertifical:iom J !i
Signature
mm 1414n Q;�Y
400 GO vnerce Aw sue, Morehead tit.,,, North Carorimi 28557
Phone: FAX: ;.5:? •247-3330 \ lntt:irli: t www.ncc.o;t,taimanagement.net
Ar -:,I ,al Opj: oA i jjy 1 Affirmail ie E coon Employer — 5r % ecyded 110% F osl ;onsumer Pbper

AIM.�.C.'ENT IJP.ARJAi' PROPE�2.')(Y 131YMER S�II',A,TEMENT
I hereto;! certi y that l :)wn propegi adjacent to 's
I Mama of Pr Own
prnperty located ! -aciv,---k--(��c-)Vzz _
(L i it, Block, Road, te.)
on _ f �-�` ---- in � � l"�- , N.C.
(11Y• [erboo ;, (1' .awn an!dlor C!,unty)
AOplicant's phon:;' #: Cf- !Mailing.A.dt •ess• 1 d C�l �� pr C. G445� r,
146 has descrihed -V Me-, as :-hOwn below the developmety to is proposing at that location, and, I
haive :no objecI:1on.3 ,) his pr;)pose].
DIMSURIT' PION I ND/UR DR OF PR1:.! POSED DEN IELOPM.ENT:
1'o be fiiHed in by pro iMy owner,proa:ring dPv kpaPtent) RECEIVED
(S �- V-- v- 43 ) t '
glifo matioia 161• ll't r I PeM (!vmer
for rermit)
Wiling Address
csylxfi�telZi p
4',5-a 3 913
Tdl : ne M, bee
OCM-Y1 HD CxTX
o v
il,-iag (Riparini. �'repertyOwrterInlsormation)
__. signature
Print or Type Name
��ti'-1f -<) o t 2 - AuMPDOWINUMberl
grranx�e D� �#.F�

C�Va tc
Ax)Ja4.i-. ENT I; IPARIAJI PROPERTYOWNER S"IFA,TEVIENT
I heretr, certi ;y that J i:)wn propert i adjacent to
I Iamc aiFPr .rty
prbr►erty loc:�ted . ! . ! o PG'IY- r COy r' 1
(L i it, Black, Road, tc.)
®a l� )O u f-i/ i. ��i L-�'� tr � � > N.C.
��• t:erbod;) (I ma and/or C!,unfy)
A.oplicanVs phon ; : cj 19 - CIT 9&S 1-1 Mailing Adt ess• Z Cci l i �� C C k A S e
-c. ��90C/
He has described t< me, as : hown below the developmety to is proposinli at that loaatian, and, i
haive no objeo--ion.3 -) his Pr;)Posal.
D&S CRI l:' i! *ION NWOR DR ► WING OF PR, :.!POSED DEN IIU OPMENIi':
i 0 be f Hed in by pri,)enty owner ,prna1.1:ting developutent) 'fkf-CO}411 z'
pCM-V' ym C;Tv'
H oil tP�oP�.fy
5k 9
--------- ____..._._ .. __ _ .._. _ ___�_�....._�^w........___ ______..____
(Xnfnt:�!!atiom fi�w•?I►rc�Pe�,. C!�wner,A,pl,l,�ing (Ripari:n�. �'ropexty Qwxter 1<nfarma4on)
for Permit)
J Of &C- ►-E e"*iL eIti j A_/C� _
Signature
Mailing Address
�
City/StateOp
qt v-
TrJtep ne N`T_e�r
3 013--
Print or Type Name
Tel �Tumber�
make

A J 1.A(,'1
,f k , , C?, nC')
e.ar f,J.
t
J
�• _ -.L`? ...! �"_.toy ar' _ ...� _......_., _..__ � ��
(Y'Va!-erbiaa;i) a> djorCOL]TrJ j)
.J.."iu cr�tJ't cl i-Jr ';t>�'i� "a I:sJ 9"me" s - f fi` o"Al l oI o-,i�l; i is d-eve';i;,t` mart pro�iosa L' { at the. r:;�Jcv�f ,'
iocatioJ
I have no obje Wtjon to this proposal.
_— I have objectic Ins to this prDposal.
DE,SCR;III11TION l►ND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deve lopment moist rill in description below er attach a site drawing)
I
�+'l . k, V let
#
a
ro JAN 0 8 ?0
WAIVER SECTIOt:
I understand that a per, doc!c, mooring rilings, breakwat,:!!r, boathouse, lift, or groin must be set
back a minimum distance of 15' from m, r area of riparian access unless waived by me. (If you
wish �towa'Ve the set)ack, y(- u musCinit0al°thjt appropria.e blank belowi.)
do w,s i to ware the 15' s 0back re quiremE!nt.
�vbGr�
1 do no-1 wish tc waive the 15' setback requi ement.
(Property Owner Information)
ri
Sr)_ll``L�� f`
Print or Ty e N e ��
M,ail1ng Addres C y
Telep_Tione Numb
Date
(Adja rent Property Owner Information)
Sigm Lure
Print i it Type Name
Mailir g Address
City/," tate2ip
Teleprione Number
Date
(Revised 611812012)

Pow �la PG��
Gapes e-at^ Icr �/ xi, C .
d
O �
PPwo ��fi
y
JA

A.�(l►JAL.C.'ENT 19PARIAII PROPERTY OWNER S'11TATEMENT
I heretrr certi y that l �::wn propezt ► adjacent to
I ifamne of Prop -rty Own )
P
rti .te rty located .1!
(L st, Black, Road, te.)
Rfo
fon 1 .� Y' �' C fa in ___ , N.C.
', terbod) ('1 .1wn and/or C!,unty)
A0plicant's phon:;' #.-- I--VYMailing Adc •ess•_..
146 Eras deserehed -t: me, as :-hown below the developmety to is proposinli at that location, and, l
hanrc no objecrion.s -) his pr;)posal.
D&S CRIT' !'ION i'. NWOR DR ► WING OF PR,:.! i'OSED DEVELOPMENT:
i 10 be fi Hed in by pri, i erty owner prna l- , :ring development)
1 1 QAC V, (f �' e, C"
5-1a N' a,
�v
CpV��
Ctub
�v W et�•�
V 0 OJ'k�/
9% 0 8 2013
DWMU ITY I
{Tnfnati!o�a Iaw• ]I'r r peril C caner A pl �l; i ag (Ripari� m .
for Permit)
Mailing Address '
Cityk'%tate/Zip
Telephone 1414M ca
�Iroperty Owner Information)
Print or Type Name
11 n � � . , `i elepbimee umber