Stone, Randal (2)

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GENERAL, PERMIT
Previous permit.#
L;O JeW np Modification ❑Cqjbplete'R6issue artial Reissue Date previous permit issued
As authorized by the State of North Carol! na, Department of Environment and Natural Resources
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and the Coastal Resourc—f ornmissign ir) an f ironmenta
ar.9a,g I environmental concern pursuant to I SA NCAC
tqJes attached.
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Applicant Name
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Project Location: nty—
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Address
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ate R9 d/ Street St 40t #(s.)
Phone # i E-Mail
Subdivision
Authorize Agent _-j
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DCW -1 EW El PTA N>14CS El PTS
Affected
Phone Riven Basin 4 6
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AEC(s):
Adj. Wtr. Body— 1J Ana-p man Lunkn)
E] PWS:
ORW: yes /(nno PNA yes/ 0
Closest Maj. Wtr. Body- Core:j
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Agent QrApplicant in Me
Permi
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Signature Pleaie'read�cbmpl,iance statement on back f P
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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, certify that 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertle, 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.nett
Revised 08/27/ 14

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
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Name of Property Owner Requesting Permit: ZZ�1�-'i C- S-/DA C
Mailing Address: I S•l woc-rc-r g fL A.6
G2F'�CNs3myca ,J� 2.7 �06
NOW-
Phone
Number: ',
Email Address: 124S7-0AJC @ 43C-LLSoy7-7-j . NCT
I certify that I have authorized
tewrera e- e
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
.S" tj4.e. c—
at my property located at 3 8 7 S TM w1fA-r t9/2 , jK"d F d/f- 7- ,
in ctAA-MXtsi
County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information -
Signature
Print or Type Name
ewe ZrA-
Title
10 I ? I I / 4
Date
This certification is valid through I I
OCT
3 12016
0CM. MI,D Cl
T�
DEC 05 2016

CERTIFIED MAIL,- RETURN RECEIPT REQUESTED
DIVISION OF` COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: R4Asis L 4 s y i.yJps s%D pqor
Address of Property: 297 S lyd sUmar DA2 , 4"opaers
(Lot or Street #, Street or Road, City & County) OF
Agent's Name : 1iwA LA�W►"eA-, c.e. Mailing Address: Z 4,
Agent's phone #: rs�4
l✓Ltna-iL +J &,;,r&_ace 0460(�qVv\cc:J Cam
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
_ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
availableathttp://www.nccoastalmanagement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If o
you wish to waive the setback, you must initial the appropriate blank below.) EcENE®
I do wish to waive the 15' setback requirement. 'RECEIVE'®
I do not wish to waive the 15' setback requirementPEC O 5 2016
w31N16
glau HD
RCM-
;ignature
e w ation) (Ri aria4PProerEqy Owner Information)
I LL
Si ture
RPPVPF9. .+srj&01/0 �� •
Print or Type Name
Isl wotwesm,ox AA.
Mailing Address
City/State/Zip
T?C-279*vCS70
Telephone Number / Email Address
la Z / 1
Date ,
CITY
I I AIR Mad % t%
Print or Type Nan
I ILID %A v �1 ?J
Mailing Address
City/State2ip
q % Ltd 0-{i��,0 11wt •
Telephone Number / Email Address
64, A, 16
Date
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