Smith, Linda

loe (Scale: ::p 10
ck regarding River Basin rules.
W!
/-r-VIDREDGE & FILL H
O'ENERAL
PERMIT
Previous permit #
New. DModification E]CpMEl plete Reissue ❑Partial Reissue bate.p.reV ious permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant
to, I SA NCAC
JRules at*hed.'
Applicant Name
Project Location: County.
Address Iq 'K�) ov -4
Street Address/ State Road/ Lot #(s)
City 'A F1110 k4n
6� Stat
[L"741k ZIP 2 P
Phone # -Mail
11
Subdivision
too*
Authorized Agent M
City-e ZIP
0 Cw ")ew APTA kES el_)r�PTS
Affected
Phone # ver Basin
0 OEA 0 HHF El lH 0 UIBA El N/A
AEC(s):
I IyV
Adj. Wtr. Body. (nat n kn)
I �
0 Pws:
011w: yes/ 0 PNA yes /(n2.;)
z
ClosestA tr. Body
770
Type of Project/ ActivityA
— I u Inv I L
U I 4,14
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) or
Finger pier(s)!!!_
Groin length ew
number
ti avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Note Local Planning Jurisdiction)
Notes/ Sped Conditions yak
'7 1 IAIAI- 19 t— I A I A -
El See note on
— - 2PA, MIM111011P.10
P I road compliance statement on, backof Signgture
qTp'Jf permit 7*
P-7
Poo �n5l
I u4 i
6he� I uing A0plication Fee(s) k#, ate Ez it
i Dat

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, certifythat this 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
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington. Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-411COAST 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

`LAMA /-516REDGE.& FILL
GENERAL Pe
A
Previous perr nit
B D
New EIM86fi�ation ❑Complete Reissue
SsUile�
artia Reissue Date previous permit. issued
lorized b*Ihe.State of North Carolina, Department of Env' !r'o'r)ment and
ePartm Natural.Resources.
!Itoastal Resources Commission in an area of environmental concern pursuant to 1 SANCAC=iq.
t arneCounty
Rules a hed.
Project Location:
41 rw
Street Address/ State Road/ Lot #(s)
Stat
-Mail
Subdivision
City--L� ZIP
--TrE KEW *TA
Phone # ver Basin
�El OEA El HHF ON El UBA 0 N/A
Adj. Wtr. Body(n
at Inkn)
Zn�
0 PWS:
yes
e 01\ PNA yes (n2;.J
Closest Maj. Win Body
Body
of. Project/ Activity
(Scale:
flock) length
Platform(s)
9g-P,Iatforrn(s)
piers) .

A47LA
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C, Davis
Governor Director
Date 1 13 - 17
Applicant Name Z i N dag SJ►1 r ¢�
Flailing address Q y Ar!1O r
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) �7r- i L' �/ & to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
1 &.4
I
es -or. 1?0 %ii c A 0
This certification is valid thru (date) I - I -a - 1 $
Signature c..
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
at (location)
JAN 18 2017
®CM- MHD CITY
One
North.Cawhna

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own. properly adjacent to 1, : w 41ci Sl' �' 's
(Name of Property Owner)
property located at `
C-
on _ Z9t xJG ( , in %/�r�u� -%C �� %/ Ab r`es N.C.
(Waterbody) (City/Town an1.
d/or County)
The applicant has described to me, as shown below, 'the.
development proposed at the above
location
have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(Indlvidual proposing development must fifl `in description below or attach a site drawing)
CIO ydu
r6 �—
sLC7 -fuj0V
JAN 18 2017
®CM- MH® CITY
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 waiv2.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.
(Property Owner. Information) (A ant Pro arty Owner In rmation)
Signature Sig re
Print or Type Name Print, or Type Name
Mailing Address , Mailing Addy s
C1ty1Stat6&ip Cifyl�taz; s 1
/U
Telephone Number Te/eph ne mb
Date Date
(Revised 6/18/20f2)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
her certify that I own property adjacent to,hry + 's
(Name of Property Owner)
properly located at
(Address, Lot, Bloc `, Ro d, etc.)
on J in N.C.
(Waterbody) (ity0own and/or County)
The applicant has described to me, as shown below, -the development proposed at the above
location.
f have no objection to this proposal.
have objections to this proposal.
DESCRIPTION ANDIOR DRAWING,, OF PROPOSED DEVELOPMENT:
'(Individual proposing development must fill'in description below or aitach a site drawing)
yr
+m �G� 40 01,0 /C F,4 Ol
RECEIVED
JAN 18 2017
DCM- M.HD CITY
WAIVER SECTION
I understand that. a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of f5'. 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.
(Property Owner Information) (Adjacent Property Owner Information)
,Signature Signature
Marc %Co..�t s
Print or Type Name Print.or Tye Name
Mailing Address ,Mail' A dress
C+ty%State%Zp C0'VSm e2i
Telephone Number Te/eph713
_ e Nu ber
_
Date Date
(Revised 611812012)