Wasley, Crystal

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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 consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Other:
Meuse 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
Morehead City Headquarters .
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
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

(Scale:
Pier (dock) length
Platforms)
Finge ier(s)
Gromength
IF number
,Bulkhead/ Itiprap length
`avg distance offshore
Amax distance offshore
yards
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A a. s
li i3 i�6y.Qe�lc (Nae of Property O ner)
property located at
ck(Address, Lot, Block, Rgad, etc.)
on , in G-1 o kc��s , 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 rill in description below or attach a site drawing)
lox
RECEIVED
APR 17 2015
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. RECEIVED
I do not wish to waive the 15' setback requirement.
APR 101 1015
(Property Own Info atQn) ("aced Property Own In ation)
�. (�
Signatur i ture
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P 't or T e Name Print or Type Name
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Ma' h Address �C atling Address
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Telep Numb Telephone Number/email address
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Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

RECEIVED
APR 17 2015
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RECEIVED
APR 01 2015
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to tr -t'<'��� b3 's
I ' Na a of Property Owner)
property located at _ _ 3 I c Is .>'ze_� L �7
L (Address, LotBlock, Road, etc.)
on �i fc�iiS , in �-�C)Lt C N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ti
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing develop�m�ent must fill in description below or attach a site drawing)
0� nt0, " 0 f� ''/"—
RECEIVED
APR 01 2015
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.) RECEIVED
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
ture
�t5 —1f4t- WRSL-:E�
Print or Type Name
-� o 16x 1 xt z
M iling Address
City/State2ip
a5,�, -76k9 Ig7K
Telephone Number/email address
-v— Z Z— 15�
Date
*Valid for one calendar year after signature*
APR 17 2015
(Adjacent Property ner Information)
SigNAV* ' %7 7wc'er
Print
23/ye�OriF7'
W&M a JJc omo(r
city/S eg-ip .� $i 'r 1fd1-YeC5-xf
Tele on hft er/ mail address -
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(Revised Aug. 2014)

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RECEIVED
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RECEIVED
APR 17 2015
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