T B Smith Seafood

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 thatthis 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 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 -
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)
(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.nccoastalmanagement.net/
Revised 08/27/ 14

A I i L) g V I y; rz JTreeT /1OOress/ JTaTe R aO/ LOT iFks/
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s' iC:�ty State ,M ZIP :f
r . A•.
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i Authorized ent L
Gty r=' ZIP
Affected $
CW EW TA ❑ ES PTS Phone # ,(�i J�'"TyS River Basin f
s DOE
A ❑ HHF ❑` p UBA ❑ N/A
EC(s): Adj. Wtr. Body
❑ PWr' ; i at an unkn
jS:
ORW: es / g
Closest Maj. Wtr. Body
�.� ..... y t`Ao
PNA yes / nto � ;
)f Project/ Activity 4 1
ock) length
'[atform(s)
g Platforni s(s=
length -^ _
umber
,ad/ Riprap length
vg distance offshore---�^�-
nax distance offshore=
ubic yards ),t
imp
fuse/ Boatlift
>reline Length`
V: not sure yes o
ratorium: n/a yes '
>tos: yes no
iver Attached: yes no
wilding permit may be required by: _
Tote Local Planning Jurisdiction)
tes/ Special Conditions
9
❑ See note on back regarding River Basin ,rules.
... 7,
AJOC.°: 6,?
0

P.O. Box 948
464 Old Causeway Rd
BeaufBrt, NC
28516
DIS
MARINE SERVICE BEAUFORT, NC
[phone]
[phone]

ADJACENT RIPARIAN pROPE1T1C OWNER STATEMENT
ram'' r....1
I hereby certify that 1 �own.'property adjacent fo r // tT .vim ' A's
(Name Pf Property a ner) .
property located at
(Address, Lot IoeK,. Road, a �c.}
- on Ciz1�,
%�'.x%' tV.C.
(INatrbocYy) (C�tytTown.d/or County?T� -
"...
:.
The applicant desc0betl to me, as. shown below,"'the.development proposed at the'abave,
locat'an
("have no•abjection ta.this.proposL '
hava-objections to fis proposal..:.;
DESCR[PTION AI DIOR Q14'Uk(ING QF IROPO$ ELOPMfEN't'
:.
- ffijd!a 14aal proposing d�rielopm nt ntc�st fi /�` n descri(�Jt% hel(o�.w/►nor afiac�r •a site draiving�
Ll
rvb I
"E iv� D:-- ._
APR 07 2017
1Nib11VER SfiC�T1ON ®C fUl- 6i11 H D CITY
n
i understand that a ter, dick, .irroorit� bakes ter, boathouse; Nft; or ruin must be :set,
groin
.p0..
bac�t a minimum fttihcp o 1,6 from r ;area #.r�parian;access unless waived by me.:(If you.
�.:.
wish #o waive.ihe setback, :you must Initial the. appra riate' blank befbw) ;..
'I do wish; to vuaive the 16''•set6a6k regwrement. —
—� I do not wish fo waive the 16' setback•requtrpment. hY. ARR 1 2017
9j
,
er 1 rn : (Aajacejrit P aperty Own ate ( TYTO
Date
(Revised 611

16
RECEIVED 04/05/2017 08:51AM
0410512017 08:42 B&J Seafood TAX)12526M775 P.0011001
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