Vandersea, Brian

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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

CAMA "DREDGE & PILL
4 •,.+...
G IV E RAL PERMIT
A BC D
Previous permit #'
ew ❑Modification ❑Complete Reissue
OPartial Reissue . Date previous permit issued
idriied by the State of North Carolina, =Department of Environment and Natural, Resources" . )
C:oastal
B Resources Commission in an area of environmental
concern pursuant to 15A NCAC (✓ # '
f t
ant Name ~� C''t'
�'"" Rules attached.
Project Location: County (
t
$s .- _-
,
Street Address/ State Road/ Lot #(s).`
StateZIP
1
-Mail
Subdivision
izecl Agent
City .� - `ZIP ✓'
Phone # River B in
❑ OEA ❑ HHF . ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body t nat an n ,
El PWS:
yes �/ no PNA yes no/
Closest Maj. Wtr. Body .• .J
0. Project/ Activity �(
eline Length
not sure yes no,
itorium: n/a ye no
os:": y no
erAttached: ye n
ilding permit may be re wired by:
4tie Lo" I PId'
IN■■■■NEEMEN
I.®®N■®®®E®■
t®®®■N®E®N..
I■®■®■®®NEE■
r®�
ElSee note on back regarding River Basin 5ples.
ca annmg Juris action)^•.-
-�l. iv_ ____r:�_��ete_

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ECIA �AkyQ egrerveA
Mailing Address: VE?g!5 P fA C�
Phone Number: �'((Gj 423 S o 2 -5
Email Address:
I certify that I have authorized _ L, o 1%,c k-zT 7x-a oG i C
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at ----I (6-1 1'0h/nl/V ,
in �A 9-�e,-cT County.
1 furthermore certify that 1 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
/C) RECEIVED
Date O C T 2 0 2016
DCM- MHD CITY
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /A-w'' L--n 0) b l-e t l \,/A Nd -e reig
ame of Pro Owner)
property located at 10IS C � � m�►'�'e ►� Ao o
(Address, LoA Block, Road, et .)
on �4� ►4 L , in N e` K-t roVk 51�0� � 5 , 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must ffin description below or attach a site drawing)
a Ce ,�-��_ ►.,"T �a w.A t% o LO �-AJ 4-- Pi
WAIVER SECTION
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. (It you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. RECEIVED
1 do not wish to waive the 15' setback requirement. OCT 2 0
2016
(Property Owner Information) (Adjacent Property Owner Information)
DCM- MHD CITY
ignature Signa re *
Print or �ype Name Print or Type Name
O S C h i m-e r/�d3� ��� c-�.
Mailing Address Ma�t g Addre s %p
1 I � t1 , U.C. I_lm.e. 1�� o it S�i nReS
C41 1'�'i' StatelZi City/St te/Zip /
Telephone Numberlemail address Telephone um er/emai�ddress
11,. 1 � a5A AU)
Date Date
ni4
(Revised Aug. 2014)
*Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to' ILAC'e M V bN0(Q 's 's
® C (Name of Pro Owner)
property located at
h2 rn �ru � Loh [
(Address, L�t, Block, Road, etc.)
on catA. A , in _I is IL a 0 —,hors; , N.C.
(Wa%rbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I nave objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must ill -in description below or attach a site drawling)
T) -�) c_ IL.
WAIVER SECTION
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
l do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Ada nt Property wn inform n)
Ignature
Vsti�,c 6 S d o
Print or T pe Name Pr' or T e N �� �� / / t ne Z
Mailing Addressif ha �, \ .(, Ns �.� 2 S i 1- aili gJ � ss /j ,
Telephone Number/email address
1'0-)�%. %(
Date
*Valid for one calendar year after signature`
Telephon Num r/ a it address
_ ) -� 7L75
Date *
R C �"'V IMQ
vised Aug. 2014)
OCT 2 0 2016
®CM- MHD CITY