Steven, Clyde

Type of Project/ Activityl� j, ; �l ,� �� "�� .,� ,,�: '� . (:i.r.• ` -
Die.. /.I....I.\ I:.....rL.
(Scale: "' )
Fixed •Finger pier(s)
Floating Platform (s)
■.■■�■■■■■■�■■■
■■■■■.�■■■■m■m�■■■■®■■■■■��A■■■.
■■■■■■�■■■■ri■■
■■■■■►��■■■�■■�■rr�■■■■■i■■■■
:::®:::::::►�®®®::::::::::::::::
G�oin length,
length
avg distance �.�ii:Dui■■►��■■■■�r■■■��■■■■r■i■■■!■■■■■■■■■■■■■■■
oreC)
max, distance offshore■■■■■■■■■■■!
MEN
:::::
�l1■faf/11r,.'71■■■■■Il■■■■■■■1��1i�I■■I■■■■■■■■■■■■■■■
�■■■�*■■■■��!■■■/■■■■■■■■■:vie:■■
■■�■■■■■■�■I
■■"■■■■��iGI%I■���!■■■O�iH3rai■■■■
Boat, ramp
■■■■■■■■■■■r�■■■■■■■■►�r�■■■!w■■■■■■■■■■■■e■
■■■■■■■■■��■■■■■■■■!�»■��;■■■■■■■■■■s■■■■
Beach Bulldozing
Other
■■■■■■■■■■■i�■■■■■■■r��ii■■!■■■■■■■�I■��e�■■■■
■■■■■■■■■■■■■■■■■■■!■■>j■■i■■m■■■■mommmmts■
■■■m■■■■■■m■m■■■■m■mar■■■■■■■■■■■■■�immmm■
■■■_■■■■■■■■��■■■■
_�■■��■.■■�■■■■_■■■■■■KEEN
IN
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
■■■
■■■■N■■011
moil
■10,20N■N
-
Rr:5rffwAT!1T1r-a■l■■
■■MM
I■■::■■■■■:■■���:yhi:�iea::::::e::Yii:
■■■■■
■��11
A building permit may be required by:
( Note Local Planning Jurisdiction) v
Notes/ Special CphOtions
I q
❑ See note on back regarding River Basin rules.
/I
ntor pleapf Printed Name
`
Permit Officer's Printed
me
i�
?�
1.�i .:
t^.
nure Pereadcompliancestatementonbackoipermit
Signature .
App6caElonFee(s)Chetl�#
IssuingDate
t
Expiration Date

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 ❑ 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 how to 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

Affected 0 Cw DEW El PTAEs 0 PTS
AEC(s): 0 1 OE HHF, EAH DUBA EIN/A
0 PWS:
ORW: no PNA yes / no
Phone# (Iq '71 '1') River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body
oil
mringa
MEMNON
0
NEON
msm'■�.■■J�m�C®i�C%0■■■■■mC'so��"��,::im'�iC�®■■�
MENOMONEE
NINE
.mm■.mmmm.m=C,I�.�...�.. �. CI�W.w 0 ■ ��
. . . . . . . . . . . . . . . . . . .
IVA
FAW00,PCEMWIN't
MMMM]iil�ll,�lu�l�g,�,'yI iop-,"

Feb, 24- 2017 2; 03PM
�+t cir�-r
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Req
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
No, 2365 P. 1:
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I A
.. A
at my property located at t`zU Ad
in
County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission tm
Division of Coastal Management staff, the Local Permit Officer and their agents to ente(
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
(�4� ��
Signature
print or Type Name
a Date ,�
RECEIVED
MAR 0 3 2017
DCM— MHD CITY
_ This certification is valid through.

Feb. 24. 2017 2:03PM No, 2365 P. 2
• ie r, sir-•j=i RIPARIAN P
i ereby csrtrfy that t own property adjacent to«! OwnEr)
(Name of Property
�
t f a ercrr � • Ec e &o f Qci
o, pe'ty ioca�o.,d a. (Address, I_v 1�8vcHc, Road, etc.) N.C.
�(CiiyPToWn ;aradlOr Gouragy)
o (Waterbody) ment proposed at the above
7; e applicant has described to me; as shown below, the develop
iow2-tir
l have no objection to this proposal.
osal.
I have objections to this pro Posa1.
®tRpA/ /4y�1V`G OF pRopoSr:D o F
��
ftahasit
e drawhff)
DESCRipTION below oag
dve6®pe�t ��sf Af in Pvn (jkdivldua% p=vaosing�.,rL�r
� osi-7c
i
WAIVER SECTION boathouse, lift, or groin must be set
mooring pilings, breakwater, me. (lf you
lu
understand that a pier, dock, a o{ riparian
access unless waived by
beck a minimum distance of 15' from my are ro riate blank below.)
v✓�Sh.to waive the setback, you nlanst initial the appropriate
I do wish to waive the 15, setback requirement.
I do not wish to waive the 15, setback requirement.
C)yjver I
119ky,
`—'30U , 1
none um
. . fir!
a
(Adjaeerst vroPera.y �yru@r Orafor'r�ation)
ro;jr� K �Z
Print or Tye Name
00S
Mailing dress
Y 1-01. n _
city/5�telzi
0`
Telephone umb r
2 N�
Dare
(Revised 6/98/2012)

Feb. 24, 2017 2:03PM
No 2365 P. 3
AUJ
�r t01
•ece.nt to6 (fame of Property Owne,
I ;eraby certr�l that 1 own property adJ
Ra:
perty located at /Ta g565W N C
(/addce�s; !_o Block, ad, et
in
r(CiYy/iodd�+ aroc6lor Cou►a2y)
°c ('U6fateF�odyi
;-�e zpplic2nt has described to me, as shown below, the development proposed at the ebove
I have no objection to this Proposal
I have objections to this proposal.
+� FL®PF11EN T
i
mu,,rill in descrip�ion ,below or atfacb� 2 she d�Hring)
� pCSCRiPTION A�©/OFZ ®f��lNf� OF PROPOSE®
(�:torit�id�ral p-oposr�g deveIPPrro � f p ;`c 0� �aPr�.�r
,ewe
DECEIVE®
MAR 0 3 2017
®CM— MH® CITY
r
WAIVER SECTION _groin must be seC
breakwater, boathouse, lift, or g
�. i�r, dock, mooring pilings, me• if ou
I , inders Snd that a p " of 15' from my area of riparian access unless waived by y
-+ um distance r riate blank below•)
o�.,k a n'i' .i o you crust iniEaal the appropriate
w' n-to waive the setback, ,
f do wish to waive the i 5' setback requirement.
415r
k l do not wish to waive the 15' setback requirement.
forr�ratior+}
(P oo ^�y owner lnfo a tiosa)
spGVC
::. - _..:, . .
Jardi,r1tePrope- O�vIer
`
Print 0r yo Name
Mailing Adda
City/Stet Zip 3 z.Z 3
-� Telephone N r b f
_ Date - - -
(Revised 6/98/2012)