Wellons Enterprises

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12TCAMA El DREDGE A FILL 67053 /"t D
ENEFlewRAL PERMIT 6ij rA B e/y Previous permit #
ElModification ElComplete Reissue D Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
wC"
and the Coastal Resources. Commission, in an area of environmental concern pursuant to 15A NCAC
"ules attached.
/
Applicant Name Ui Project Location: County
Address Z, Street Address/ State Road/. Lot #(s)
City
State ZIP
Phone # -Mai Subdivision
. Authorized Agent cityI ZIP
Affected 0 M .% 0 / EW PTA 0 ES 0 PTS Phone # /River Basin
/44
0 OEA 0 HHF 011H 0 UBA El N/A
AEC(s): k(nat im Adj. Wtr. Bodya /Jnkn -�
0 Pws:
Closest Maj. Wtr. Body
01RW: yes / no PNA, yes no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s
Floating Platf9rm(s)7—
Finger pier(s;Q4,
Groin length "
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
.................
cubic yards
Boat ramp
Beach Bulldozing
A Other
Shoreline Length
SAV. not sure yes (."n
Moratorium: n/a yes ",.no
Photos:
Waiver Attached: no
A building permit maybe required by:
.(Note Local Planning jurisdiction)
Agent or ADDlicant.Printed Nam Perr
Signature JPJ 9read compliance statement on back of permit" Sign
(: �',
Applicajign Feq(s) Isso
Check #
I
(Scale: I
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El See note on back regarding River Basin rules.

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 0 Other:
0 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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888-411COAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date�1w`� _
NameofProperty Owner Applying for Permit:
t&1Ions 'E4ervxisES
Mailing Address:
M u ce6a A (-',,+�j N,c =2 9'5
I certify that I have authorized (agent) fir; c JC-f 3 Y�2 t5-7 ? to act on my
behalf, for the purpose of appl ing for and obta
install or construct (activity) p ���3N
at (my property located at)
all CAMA Permits necessary to
This certification is valid thru (date) D) .
Property Owner Signature
RECEIVED
OCT 14 2015
DCM MHD CITY
Date
RECEIVED
OCT 0 8 2015
DCM- MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
�a,nndn � �r�ber�
I hereby certify that I own property adjacent to 116 RS's
(� (Name of Pr perty wner)
property located at , i 9 M'}"IQYi'�i� �6��, uS Q,U
on
(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.
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
RECEIVE
OCT 14 2015
DCM- MHD CITY
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.)
AW I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
gnature Sa nature
lQ� n�c��
yt o e ame Print orwTyp N me
TTin Ad Tess aili g Agd`ress
'ri
City, tate'p City/St 2i
T one Nu er t7 EC C h B WL
ne Number D
Date G v Date
OCT 0 8 2015
(Revised 611812012)
DCM- MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
�r i. -L
I hereby certify that I own. property adjacent to F i:i"0 's
(Name of P perty caner)
property located at Jr- D A,16LU�Ve'
e
(Address, Lot, Block, Road etc.
on , in ,ntCr 8C'Q N.C.
(W erbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
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)
OCT 142015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be seOCT 0 8 2015 -
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.) DC�_ ��®
CIT
I do wish to waive the 15' setback requirement. ;
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Si nat re
Print or y a eo
S
ing A dress W/3 Ad !ss
Cityate 2 C/,25 21 C 173 La
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T lephone Number r, T- hone 1jer,CR US
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Date Date ,
(Revised 611812012)

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