Thompson, Michael

Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platforms)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
3 BoathouseBoatlif_
Beach Bulldozing
' Other
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Shoreline Length
SAV: ; not sure yes n
Moratorium: ' n/a yes n
Photos: yes
WaKerAttached: yes (MV
(Scale: )
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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, certifythatthis 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I awn property adjacent to _ (?t�' ';,, ,s
property located at L, �. (Name of Property Owner)
{Aaaress, Lot, Block, Road, etc.)
on in % t "-s J
N.C.
(Waterbody)
(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.
DESCRIPTION
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DIOR DRAWING OF PROPOSED DEVELOPMENT
WAIVER SECTION
DEC 21 2016
I understand that a pier, dock, mooring pilings, boat ramp, 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 to waive 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.
{rroperty Owner Information)
Si-onat�url�
P . t or T pe Na e
Mailin Address
t / err-f� A/(,
citylstatel ip
Teleph7/,,'
a u berlemail address
rE
Date d I
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
gngture*
Print or Type Name
Mailing Add ss
citylstatelzip- �3 i
Telephone Nuniberlemaif address
it I
Date*
(Revised Aug. 2014)

ADJACENT RIEARIAN -PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to Phdvidl= 4 a y. x 's
(Name of Property Owner)
property located st d'--L t ,
(Address, Lot, Block, Read, etc)
on i F , in N.C.
(Waterbody) (City/Town an o County)
The applicant has described to me, as shown below, the development proposed at the above
locafio .
7. 1 have no objection to this proposal.
I have objections to this proposal..
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT .
(Individual proposing dev,616pinent musi t'i(l in description below or attach a site drawing)
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DEC 21 2016
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat camp, 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 to waive the setback, you must Initial the appropriate blank below.)
l/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 1V setback requirement.
(Property Owner Information) (AdKent Property ne Information)
Sr aturf1 ✓) Sigo pe"z.—.I_ t
P ' t or Pq�e Na6e Prinf or Type Na et f
Mailing Address Ma g dre
ew
cifylstala(Zip City/Stat
TelephnoeIN u berl emeT address Telephone N ber! ail address
I/7 !
Dale- rDate
(Revised Aug. 2014)
"Valid for one calendar year after signature*