Valente, Pam

Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A r a
AEC(s): Adj. Wtr. Body ' < ° (i ! =- ( `'r f-- (Hair /man /unkn)
Closest Maj. Wtr. Body
ORW: yes /! no, PNA yes / no Crit.Hab. yes J noj
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Photos yes k 66
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building permit may be required.
■See note on back
regarding River Basin rules.
Notes/rSpeciall Conditions
App6ca ion Fee(s)
��L

d
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 that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
0 Tar- Pamlico River Basin Buffer Rules
El Neuse River Basin Buffer Rules
0 Other:
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 howto comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400'Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd. (Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604 New River Inlet- and Pamlico Counties)
919-733-2293
Fax: [phone] 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

Ai ;A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date I q vle—,w r
Applicant Name
Mailing Address 856 &a- owtu cpr V L
John E. Skvarla, III
Secretary
l «.� ba
o y 737
I certify that I have authorized (agent)
6&,-
to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
bcoj4A 6L+ eSC.1 &6A dock , at (location)
UP.
This certification is valid thru (dated aC'-, o? o 1
Signature
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
0
i z IECNI3
r•
JUN 2 6 2014
J,
DCM MHD CITY
ne
NorthCarohna
Naturally

ER
----- - . - - - .1 hereby certify that I own property adjacent to -
property located at O 1 h QM_ OW-L , Vr - A
on NY-C &Cej(, (Address, Lot, Bloc
(Waterbody)
-- - -- �s -
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiory
�_ I 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)
t�}- av� ew5
�acl�.
� �tECEIV�i�
JUN 2 6 2014
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or gst be set
back a minimum distance of 15' from my area of riparian access unless w verbv me. I frou
wish to waive the setback, you must initial the appropriate blank below.)ti�
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop ert Owner Information) (Adjacent Property wner Information)
Signat Sign ure
m �Q Pali-�
Print r Type ame - P ht or Type Name
�� `lulu -v 104 5IM dr-AT
Ma I' ddres Malin Address
-i- N C o? 0U �•Iewpoter NE- -138S710
City/Sta id City/State/Zi
22 - 7a S -�-�f 9 a.5g- 2,-r- 6-?6 r
Telephone Number Teleph Y
ne umber
b 6)6 l
Date Date
(Revised 6118,12012)

I hereby certify that I own property adjacent to
! 5-14 P.
v
I
property located at X"-� 1u '
�� �eee (Address, Lot, Bloc, Ro�d� tC•)
on , in L:O�y'�2 2.# , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
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)
tonil boo+ I i M Buis n� cfvc�C.
RECEMED
JUN 2 6 )n1A
�0 @9J DCMMHDCTTY
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin set
back a minimum distance of 15' from my area of riparian access unless waived by (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. 'A
(Pro pe Owner Information)
Signetrw -
Pr Rr Typr Typ Namur '
V`1t)eo,1 V" -'
City/StQ�e�/lpl TO A I—V 44 1q7
TelephoneAtumb'r, r
Date `f
(Adjacent Property owner mrormanon)
re
Print o�r, ,Type Name Mailin Address
City/Sta(e jip �y01
S �.. �.t s��.
Telephqne IYumber
SlIgly
Date
(Revised 6/18)2012)