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A building permit may. be required by:
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See note on back regarding River Basin rules.
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( Note Local Planning Jurisdiction)'-
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Notes/ Special `Conditions
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Agent or pplicant"PKinted.Narne
RermitbfficersPri t d
ame
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Signa ease re d compliance statement on back of p rmi "
Signature
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' A`pplication'Fee(s)
�;,�; �;: t ,e :i�,y .r,� .ti,. .°
Ci�ecic# Issuing Date
d �'• v ;, .. , ° ca �j.'v'`"' ,�.� .?� (y � v , Mo :;p- �
EXplration Date
7 �i. , � 4, , § 4 r .. , '
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 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 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: 252-247-3330 Fax: 252-948-0478
(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: 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement.net/
Revised 08/27/ 14
acted ❑ CW EW *A ❑ ES
LIOEA ❑ HHF ❑ IH ❑ UBA
(S)' ❑ PW :
W: ' yes / no PNA yes / o
pe of Project/ Activity ;
er (dock)length
xed Platform(s) `
oating Platform(s)
nger.pier(s)
rorn length
number*..,"_....--w-
Jlkhead/ Riprap length-----w
avg distance offshore---
hax distance offshore•---R
3sin, chann`efi"--""'�
cubic yards- . - - N
Dat ramp
46 Bulldozing"""`""""
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horeline Length
❑ i TS Phone # .r .fiver
❑N/A Adj. Wtr. Body
Closest Maj. Win Body } r'
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(Scale:
in unkn
oAV: not sure yes frio I
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1 11 1 1 1
1 1 1 f 1 i � 1
1oratorium: n/a yes
hotos- yes n
VaiverAttached: f no
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building permit may be required by:
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❑ See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
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1 A
lotes/, Special Conditionsi
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c•
ent or lic20
ant 'Printed Narne
Permit fficer's Prinf d amp
na leaseread compliance statement onbackofp. mi �`*
Signature
„
)aljcaiion Fees)
Check#
Issuing,Date
Expiration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: a L'. J ( V
Mailing Address: 5576,,
�e? d5 boLl o S
Phone Number: "! 1 7 8 , o x 20 �--
Email Address: j'Vt Q C PiX Q, CO.,
I certify that I have authorized rn Gr :)%4e 5 dOV4481 oK, IC,,S Lok 5�•
AgeR I Contractor
to act on my behalf, for the purpose of applying for and obtainingg all CAMA permits
necessary for the following proposed development: %�' a'it
boa+ 51;p
at my property located at 2 i E v C4-1. S i► , i r 1 Qcd C► �j �" G
in CZP4+'M a fl- County.
1 furthermore certify that I 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
Title
>
Date
This certification is valid through i I
RECEIVED
MAR 0 2 2017
DCM- MHD CITY
RECEIVED
FEB'2 0 2017
DCM- MHD CITY
La
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1 t (k e- 5 u votp a 's
4 r� (Name of Prop Owner)
property located at is - V 5� t . e �+ _ c-.
(Address, Lot, grock, Roa , etc j Kv0, -(y
on p t✓ E Sod wt , in Nl ,AC: - diaC , N.C.
IJ (Waterbody) (Citylrown dior County)
The applicant has described to me, as shown below, the development proposed at the above
tecatio .
1 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)
Add` bocj
S Hach. W
/t 6 0,rf 5 /1
}
JAN 3 0 2017
®CM- D Gay
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 VNaive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjgen,YroprVvntnfration)
Vale
0
or
Mailing Ad ss
. sue., N G. 2--
Q1y1Statelzl� _,2 r S ^ �
Telephone Number b
Dare RECEIVE®
(Revised 611812012)
0 9, ?n17
ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR LAMA MINOR PERMITS
I hereby certify that I own property adjacent to , - G !,� I
(Name of Property Owner)
property located at � f' V 34'. - ("
e Address, Lot, Stock; Road, etc.) �y
on q U t C7�++t Gf , in d r e �ct� '�'i Q' , N.C.
(Wfiterbody) (Town and/or County)
He has described tome as.shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Oce.gAa.s
Signature
G. f #4c,rwy -Pq-rP-
Print or Type Name
;L6 X . 10 C. t . 1$ q4=�
Telephone Number
I. 0. r7
Date
V212017
Cortnect(GIS Feature Report
G' S
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Caneret2
Printed January 02, 2017
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Disclaimer
See Below for Disclaimer
- _ - -
— Address Poirs
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Parcels - Updated 3 ' S-)C16
Cemerlires
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NC Railroad Right o
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CCoourty Bourdary
Other Court/
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Acreage
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Parcel Dimensions
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The information displayed by this website is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and
4 frier public records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for
1 erfication of the information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does riot
uarantee that the data and map services v.dl be available to users without interruption or error. Furthermore. Carteret County may modify or remove map seroces and
cess methods at will.
fOd boa,4 s I"IP_ RECEIVE®
MAR 0 2 2017
htlps:/Icarleret2.conneclgis.coinlDownloadFile.ast-x?i=—ags_mape6526668e3b242ae968821bc75330efbx.hlm&t=print DCM— lV HD CITY 111