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❑DREDGE & FILL
EIVERAL PERMIT
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 [)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, certify that this project is consistent with 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 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 comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
Morehead City Headquarters Washington District
400'Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
;i) :c� ��i'3`?__t?.11i y�: t ::� j..3 � .c3L Fi.a�i,,.f ,? 1; t� n]i�71 S ;ra
Applicant:
Date:
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.
Disturbanoe.total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
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
Dredge ❑ Fill ❑. Both ❑ Other
3 CJ
sc�
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 ❑
A4j;A
-
NCDENR
North Carolina Department of Environment and Natural
`G. Division of Coastal Management
Pat McCrory ` * Braxton C. Davis
Governor q 11 1 Director
Date C> (" 3
Applicant Name L q rr- ! j ',-Z)( O-A v�
Mailing Address 1() '2, (emu, e-^, S Z
AktNt�k>-c- ScOAk v. 2-�iSt2
Resources
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) ('� C_�C ��,.n�l to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
1 o X 30 �P Q c.'-^"_tie)'r � , at (location)
�-
This
Signature
valid thru (date) t- Z ( - % L(
400 Commerce Ave., Morehead City, NC 28557
Phone: 252-808-28081 FAX: 252-247-3330 Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NorthCarohna
Naturally
Aug 221311:34a Diesel Equipment Company 336 272 3189 P. 1
21, 2013 2:1A go.2975 P. 2
ADJACENT glpARIAN PROPERTY OWNER STATEMENT
1 hereby certify that 1 own property adjacent to Is
( of Property owner)
property located at ----I 005 _,QA S-N
(Address Lot, !)lock, Road, etc.)
on e,,..1 . in 0AXt.,41 L RO.Air N.C.
(Waterbody) (City own andtor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X I have no olfaction to this proposal.
f Ism objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lncf"ikrldual propos/ng development must fill /n descr/pfion below or attach a site ckawing)
��� �.�-oc�1-:�S d ve.►L
a e9
a �
WAIVER SECTION
I understand that a pier, dock, mooring pilings, Ixeakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (11 you
wish to waive The setback, you must initial the appropriate blank below.)
><1 do wish to waive the 15' setback requirement.
I do not wlsh to waive the 16 setback requirement.
(Ppe y Owner Information)
A C T % �Ji L7tiA+�
Fvint or TY0 Name
Address
Tokpbom Number
�•z.t-tom
Date
(Adjacent Property Owner Information)
1._J� Cl % _ w -'-:> f` Q ". , V _ 4. A �,
JI llfl8 ^V--�+>(� `
C3.Y Y. l.r-\ G"f 1�
Print or Type AAM
Mt�Address
..eer,�kaY u %,I C. a-11A%.v
City/5ratsV�'ip
c�csU'1_-
Tokowne Nun bar
ZZ !!
Date
(Revd BJY&2012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Lac rtj S) De r1 I
(Name of Property Owner)
property located at 1 O3 % e.—
(Address, Lot, Block, Road, etc.)
on in le,, i. e_ 'recta. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc o
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)
v
J
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.)
-IWI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Six
i a re
pe
Mailing Addre
l A *J.- A- k
City/State/Zip
Telephone Number
Date
(Adjacent Property
Signature
Print or ype Name
on)
Mailing A dre�
t o / C, /, 16 /,g-/- �If�it is�-g C'(n
City/State/Zip � � f
d fbr� �a �� - %VC .2
Telephone Number IV
c7S 2 - 73) - g5'K,,0
Date g- Zl -13
(Revised 611812012)
-ConnectGIS Feature Report
Page 1 of 1
Ca N N E TG' Cart
Printed August 21, 2013
WEB HOSTING
�4. Parcels (Updated 07103,2013)
1 - Centerlines
� - 6
County Boundary
other County
f . :all other :alues>
79 G -,
Cart
60 PIN
1846 Acreage
�-o Parcel Dimensions
1841
Lot Number
979
'E I• N �� M �I r
� v
U1 L; 541
i
t _ 1480 9
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- 0422 1 _iii Fret
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