Wadsworth, Albert

AMA El DREDGE & FILL
N"14" 67002 A B D
ERAL PERMIT Previous pern kc)
ew ElModification ElComplete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal ResoKces, ommispon in an arga of environmental concern pursuant to 15A NCAC UV
Rules att#hed.
16C"'J County Name Applicant Project Location: A --
Address— Street Address/ State Road�j Lot (s)
V"
City t^-v Sta
te ate ZIP
Phone # %Mail
Subdivision
k-4 I
Authorized Agent city ZIP
0 Cw w River asi
Affected ❑7fTA DES El PTS Phone # n
0 OEA El HHF DIH El UIBA 0 N/A
AEC(s): Adj. Wtr. Body —11� Jat /man "unkn
0 PWS: jx
V
Closest Maj. Wtr. Body
ORW: yes PNA yes/ CA
Type of Project/ Activity
Pier (dock) length t
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_
Groin length
number
Bulkhead/ Riprap length
ayg distance offshore-�
max distance offshore
Basin, channel
cubic yards''"'"
Boat ramp 44 2h
MUNIM
Beach
Other
Shoreline Length I LA I
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by: LLL
(Note Local Planning jurisdiction) \ -, 1,. /)
i'j � 1, 0 See
t
,14
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature *7,P ase read compliance statement on back of permit" Sigg.4tu
ApplicationFee(s)',Check# issumg ate Expiration Date

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
landowners).
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:
[M Tar - Pamlico River Basin Buffer Rules Other:
E] 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/ I-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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to�e'f" :c w o
(Name of Property Owner)
propel y located at -
A- AV-
(Addre s, Lot, Block, Road, etc.)
on 15$ v 5-:�„ L) t , in d r N.C.
(Waterbody) (City/Town and/ r 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 fill in description below or attach a site drawing)
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 by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
RECEIVED
I do wish to waive the 15' setback requirement. SEP 112015
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sign/'r
Print or Type Name
Mailing Address
City/State/Zip
<-,<, / '2-)1
Telephone Number
Date
(Adjacent Property Owne Information)
41
Si at
Print or Type Name
Mailing Address
. City/State/Zip
rya �d
Telephone Num r
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to AL/ "�S r a 4 r -�-� 's
. (Name of Property Owner)
propety located at
�- - (Ad ress, Lot, Block, Road, etc.)
on u F Sa of in a r d , N.C.
(Waterbody) (City/Town and/or C unty)
The applicant has described to me, as shown below, the development proposed at the above
location./
y/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(individual proposing development merit fill in description below or attach a site drawing)
l,3X a
F1 0AtP
RECEIVED
SEP 111015
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 by me. (+you
wish to waive the. setback, you must initial the appropriate blank below.) 4e Fo
I do wish to waive the 15' setback requirement. *tie j�f
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name I
11 07 U' '4: L�I%�/+ir �r
Mailing Add ess
-BAN d F71- 337!�12
City/State/Zip
Telephone Number
Date
(Adjacent Property Owner Information)
ign�aure J
V(m r,c�
Print or Type Name
S'ols- �� L. E
Mailing Address
City/State/Zi
- � 6. 3 -2
Telephone umkr-,
� �
Date
(Revised 611812012)
j

AMA /�❑ DREDGE & FILL N? 47108 C
GENERAL PEMIT Previous permit # W ?1 / C
C�New ❑ModificationROmplete Reissue ❑Partial Reissue Date previous permit issued S ' k.� O
As authorized by the State of North Carolina, Department of Environment and Natural Resources )
and the Coastal Resource Commission in an area of environmental concern pursuant to I SA NCAC -7 l
_ J , � Rules attached.
Applicant Nam, " / VC)f+4) Project Location: County_ ���T��~��
Address' ` 4` °2 ic /' Street Address/ State Road/ Lot #(s)
City jn pr P State d zIP33 � Z 5 -0 13 G�'lf/ CLf
Phone # '(��0' "'��� Fax*,( Subdivision
Authorized Agent � r f C ` ((� City
❑ Cw
Affected
AEC(s):
❑ OEA
❑ HHF ❑ IH
❑ PWS:
❑ FC:
ORW:
yes ; no
PNA yes Kno
Type of Project/ Activity
❑ ES ❑ PTS
❑ UBA [IN/A:
Crit. Hab. yes / no
r.
Pier (dock) length �( U f tx 16 _
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathous oatlift J
OXII
Beach Bulldozing
Other
Phone # ( ) Ri `r Basin i �c (J
Adj. Win Body hunkn
Closest Maj. Win Body C')4"
....
Shoreline Length
SAV: not sure yes n., L
' Sandbags: not sure yes n _1_. L....... �._..._._
Moratorium: n/a yes o 1 '
Photos: yes —�
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
tir l_� Le"'�A" 74,
(Scale: "4. /'T1 )
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name „ Permit i _ �r's Signature
Signature ` Please read compliance statement on back of permit' Issuing DateEx ration ate
100
Applicationes) FeCheck # Local Tanning Jurisdiction Rover Flle Name

Styron, Heather M.
From:
Sent:
To:
Subject:
Begin forwarded message:
Jasa Ellis <[e-mail]>
Wednesday, August 26, 2015 7:49 AM
Styron, Heather M.
Fwd: Permit Application
From: "Wadsworth Developers"<albert@wadsworthdevelope rs.com>
Date: August 10, 2015 6:18:21 PM EDT
To: <iasa5 @ ec. rr.com>
Cc: "Albert Wadsworth \(W/D\)" <abert@Wadsworth develope rs.com>
Subject: Permit Application
To whom it may concern,
Please accept this email as authorizing Eric Ellis to submit and sign any documents as it pertains to the permit
documents requested by the city or any other associated agencies necessary to obtain complete permit.
Thank you again for your assistance and feel free to contact me with any questions or to confirm the authenticity of this
email.
Cordially,
Albert Wadsworth
08/10/2015
Wadsworth Developers
561-582-6976 Office
561-582-6977 Fax
561-271-6080 Direct
RECENED
SEP 111015

Styron, Heather M.
From: Jasa Ellis <[e-mail]>
Sent: Wednesday, August 26, 2015 7:55 AM
To: Styron, Heather M.
Subject: Wadsworth permit
Albert Wadsworth is located at 5013 Holly Lane in Mitchell Village in Morehead.
His home address is 1120 N Atlantic Dr Lantana FI 33762 phone # [phone]
I'll drop the signatures by the office. Thanks, Eric
RECENEo
SEP I I IM
444�3 or-A4
1