Taylor, Johnathan

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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 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 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters,
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

• CAMA / ❑ DREDGE & FILL
4T '
GENERAL. PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
a !
and the Coastal Resources Commission in an area of environment concern pursuant to 15A NCAC
Rules a ched.
p Project Location: Count rl ,'' VAJ
" Street Address/ State Road/ Lot #
'P r Subdivisio
ry oar City ZIPS s
X11PTACCW EW ❑ES ❑ PTS Phone #F�Rly r Basin
Affected ❑OEAHHF H ❑ UBA ❑ N/A
AEC(s): Adj. Mr. Body <�.-� �nanunkn ❑ P OFc:
ORW: yes / 1 PNA yes / Crit.Hab. yes / no Closest Maj. Wtr. BodyC-
j
Type of Project/ Activity i
` (Scale: F )
Pier (dock) length
Platforms) --
Finger pier(s)AL
.-
Groin length
numb
Bulkhead/ Riprap length - - -- - - -- — - -- - — - -- — — — -- - — — - - --
avg distance offshore +„✓'
max distance offshore Q.
Basin, channel

ADtLACENT RIPARIAN PROPERTY OWNER
TATEMEN
reby certify that I own property adjacent to �J 4;V �,Z
s
property located at (Name of Property -Owner)
A 70
q on (Address, Lot, Block Road etc)
(Waterbody) in f.N.C.
(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.
DESCRIPTIO
(Indlv,dual proposing NAND/OR DRAWING OF PROPOSED DEVELOPMENT
development must rill in description below or attach a site drawing)
WAIVER SECT"ION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or
back a minimum distance of 15'from !.ny area. of riparian access unless wai%
wish to waive the setback, YOU must initial the appropriate blank below.)
,I do wi 0 waive the 15' setback requirement.
0 not wish to waive the 15' setback requirement.
(property Owner Information) Adjacent
Property weer Information)
Vau Si t re_ 4Pf
Wtu-re
ZJ
Print or Type Name
2 Print fint or TxName
-2-1
Mailing AWddess �R1.
M ifing Addresj--'�--
014- IV6
-503 Cit lstatelzlp-
Telephone Number --.- -C - ----2-La-< 0
7 Telephone Number
Date D-It7 -OQSG<�
Dateu Q0 14-f
(Revised 611812012)
. (if you
JRECENED
Y

toedJo me, as shown below, the development proposed at the above
objection to this proposal.
ections to this proposal.
DESCRiPTIdN A►N®/OR DRAWING OF PROPOSED DEVELOPMENT
s� (/rid "'dual prop®sang cfevel®prnea�f gust loll in description below or attach a site dfawing)
c
4qir'PrSO4f 10
30 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 bye�t� srn
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
- - - RECEIVED
(Property Owner Information) (Adjacent Property Owner Information)
/� Q�� MAY 18 7015
(A V adl—k" // �✓UL2� "rinly GUY,
S' ature Signature
Print or Type N me Print or Tye Name
Mailin Address Mailing Addre s
City/statemp ? City/statelzo ,� Fij"
Telephone N tuber Telephone Number 10
72
Date Date �C'i111�
(Revised 611812012)