Stephens, Timothy Mark

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AMA
.' REDrE & FILL new S+
K!� 66743
A B D J"
ERAL PERMIT Previous permit #
eW ElModification El Complete Reissue El Partial Reissue Date previous peFmit 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 1 ? Of�
yles aAached
Applicant Name
v /1 Project Location: County
Address Street Address/ State Road/ Lot #(s)
State ZIP"
City. L-1-1 V' Pc\
Phone #
E-Mai Subdivision
Authorized Agent City
Affected El CW *W *A S El Prs Phone "46ver Basin A,
0 OEA 0 HHF DIH MA 0 N/A
unkn
AEC(s): Adj. Mr. BodyVVT
PWS: (nat /Can,-,',/
Closest Maj. Wtr. Body s
0RW: no PNA yes/
00
Type of Project/ Activity
. . ............
(Scale:
Pier Wnck)_��
Fixe
Float
Fing
Groff
Bulk
Bash
Boat
Boat
Bea(
Othi
Sho
SAV-
M o wJ
Pho
W2
UNNOMMEMEME
M
WMOMNM
MMMMMMEMMNMMM
oPlatforms-`—;
length
r
max distance offshore
ME
,channel
cubic yards
ramp----
iouse/Boatlift___,--
-i Bulldozing
line Length
not sure yes t�c
1, I
torium: n/a yes )M
nll
s: yes
MINENIMMMMOMMMINEEMEEMMMMINOW11
MEMEEMMM
MENEEMEM
MEN
INIUMMEME
MONSOON
trAttached: yes
0
MEIN
Now
PJAXEMORWIRNME
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A building permit may be required by: �,. I p.,
Note Local Planning jurisdiction) N
,11!otes/ S ecial Conditions
Agent orAppl* riAtedNarhe
Sign uce (le' apse read compliance statement on back of permit"
Application Feels) Q , hock #
note or) back regarding River Basin rules. i .0

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, 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
Neuse River Basin Buffer Rules
7 Other:
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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/14

AMA REDGE & FILL s
A BC
ENE PERMIT
D
Previous permit#_,F'
evv ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
a
As,authorized by the State of North Carolina, Department of Environment and Natural Resources 4
3
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
fi
'ti j . j .. Mules attache
r
Applicant Name '_' '4" '� `, ,� `` Project Location: County
.Rr',9
Address B �� f Street Address/ State Road/ Lot #(s)
City y State
Phone #E -Mail r
) `,��f "w t£,; ; �Subdivisio� 4
,,
Authorized AgentN d ° t9:F f' -�' City, ZIP
t
TA ❑ PTS Phone # �jr �` fver Basin
4ffectecl cw�)
ABA
AEC s : ❑ OFA ❑ HHF ❑ IH ❑ N/A r '' t�
() Adj. Wtr. Body ;. : ^ -�4�, fs= '„
/ixian'%unkn
4 PWS i4 (nat
DRW: s no PNA yes / r10 ' Closest Maj. Win Body
P i
Type of Project/ Activity�dl"
Floa
Fing
Groi
" Bash
Boat
Boat
Beac
Oth
Shor
r a —LA 1—
(Scale: j .. LIP )
a
i length
11
1
oil
I
■
IN
IN
M
NZ
M
E
on
max distance offshore
,channel
ME
MEN
M
Es
cubic
yards
ramp
NONE
M
NOMMEM
'-I Bulldozing
ME
0
IV
2219
M
ME
NONE
MEN
owed
M
I
I
MCI
5
1171
=
fz—
.,;h
not sure yes no
ON
No
MEN
w
MWEREM
NONE
No
Phot
`W.aiV
yes
A building permit may be required by:
(Note Local Planning Jurisdiction) y``a
�dtes/ ai ecial,Conditions
r yyy---
❑ See note on.,back regarding River Basin rules.
f
!'
PermitOfficer s Printed Nam
1
i p
:a;ereaocompliance statement onback ofpermit " Signature j"
w...sMw..rl ', l' ^.,.� � � Sn _dr '.j ..nn •r ia" i F ..i ^ �' .'..��a
Check# Issuing Date —� Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date -11• ! &
Flame of Property Owner Applying for Permit:
Ii ran b4 k , Mot r � 9-6 n k mar, c.
Mailing Address:
I certify that I have authorized (agent) Brno IC--5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) .SEa \Na t I ,
at (my property located at) -3 t '? Ea--) \1 54-r e_cA - L!ape- LeX-VN 1 .
This certification is valid thru (date)
Property Owner Signature Date
RECEIVE®
JUN 15.2016
DCM- MHD CITY

0
' 3
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to M O+k C- k j ,s
of
property located at a it �E- t! (Na Property Ownr)
(Address, Lot, Block, Road, etc.)
on 4DUU.
—�� n L�,nA . in T� � J �,.x---�- , 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.
I have objections to this proposal.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
:ZVI
ish to waive the setback, you must initial the appropriate blank below.}
do wish to waive the 15' setback requirement. RECEIVED
I do not wish to waive the 15' setback requirement. JUN 15 2016
(Property Owner Information) (Adjacent Property Owner lr ioh0 H ® CITY
�.V14tJ
JAL"
nature Sig a re
gno4 her irk- � eph n < i ,�
Print or Type Name Print oi Type Name
Mailing Addrqss Mailing dlessA
7 A/
City/State Citk�'State/Zip y t
Telephone Number /email address Telephone Number/ email ddress
1� 3 Dale t C�-..�1
fiat
(Revised Aug. 2014)
*Valid for one calendar year after signature*

T
ADJACENT RIPARIAN PROPERTY OWNER STATEME T
I hereby certify that I own property adjacent to—V1 m k em 5 ,s
(Nam of Property Owner)
property located at
(Address, �ot, Bloc Road, etc.)
on 2 in - , N.C.
(Waterbody) I (CitylTown 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.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
4-o Q-mne-4
V,-"6-fk R 5 k
-4R-okwokA 0� ')O�n 4aA,V-,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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. RECEIVED
I do not wish to waive the 15' setback requirement. JUN 15 2016
(Property Owner Information) (Adjacent Property Owner In r 'on
•� I�HD CITY
—
Signature Sigt�c�aure
Print or Typ& Name 'T Print or Type Name
ailing Address Mailing Address
PitylStatelZJp CitylSfate2ip 7-9
Telephone Number/email address Telephone Numberl email address
Date [ ,,. Date*
(Revised Aug, 2094)
*Valid for one calendar year after signature*