Whitman, Gene

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2D-0
AMA ElDREDGE FILL, =NERAL PERMIT,
Previous,, permit,#
ew. E] modification ElCmpletei 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 Resources mmission ip an hre gt of environmental concern pursuant to I SA NCAC
les attached.
Applicant Name'�O
Project Location: County C" ::;)--f <-/
treet Address/ State ad/ Lot #(s)
Address- C S
City 0"21 StatX6 Zip A"'
Phone # E-Mail Subdivision
Authorized Agent f Ir ' VI Ci 2�r�t" ZIPA;1V I 4)_
Basin
El CW ?I* A El ES 0 PTS Phone# <, 4,4
Affected 7
AEC (s): El OEA D HHF ON El UIBA 0 N/A Adj. Wtr. I d ;e r NQ /man /unkn
EJ PWS: 4 '
Closest 6
Maj. Wtr. Body— 1�k_')<,- t-e J..,*-
Ce PNA yes ORW: 1190,
77 7,
Type of Project/ Activity (2 1-
.
Pier
Fixe
Float;
Fing
Groi
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Bow
Bow
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avg distance offshore
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Agent, a. plic_ap�'i;._djqme=7
Permilfficd/Kri tWFlam

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, certifythatthis project is consistentwith 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/ 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

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: h''G k) k r
141-1
Mailing Address: .4 1 4 O
Phone Number:
Email Address:
I certify that I have authorized
/ K
Agent / Coni
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: o r,5
P11
RrYQ4Z4j+ A--, .7
at my property located at ',-��-( �C''_�lwS
in k2C County.
.1/ E�'
I furthermore certify that I 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:
z
Signature
Print or Type Name
- .0 W Aj-<!, l -
Title
[�LiIl / 6
Date
This certification is valid through I I
RECEIVED
JAN 12 2017
DCM- MHD CITY
RECi:NE®
DEC 2 9 2 IS
DM. MHD COTY
D

ADJACENT ritNT RIPARIAN PROPERTY OWNER STATEMENT
hereby
I own.property adjqce
he certify that I oWnto
DESCRIPTION
rent must fiffin -des
-A
1EIVEb'.
JAN 12 2017
Ca.
M- 14HD C ITY4 !J
roe I ry
IT
WAIVER S)IMPON
un'derstan.d-th"at.a'pier,.-dock, m'Qoqng*-pilings, ....... . O(oa'...At6.r,bocithbuse,,.Iift,orgroin'mustbo8ot
":
back.'a minimum inimum di8tAhde b f 15:from -y, area of Ap nawaccess unless waived by me. (If you
wish to waive .the .setback; -y6b' must .,-11hit"
Idl'the, appropriate, blank below.). -
CE.'.,:.,.,,,'.
I do Nosh. to Waive. W61 5! setback requirement. REIVED'
-"
i do not
wishto waivethe 15'setbaok requireMdrt. DEC 29 2016.'..
.
Trop.64 OW fti 11,06i it (Adjacent Property Owner infcDCW M H D C.
g . uow
Si re Sigiiature,
CM
Prin t q rT )q;&me
I V1 Print or Type -NAme
LD qg, j
L-50X eo 2 7 )k-
Aj�![Zrn
Address I Address
-77
/V 02
Cify/Sta Zip.. -ty a VStaR1Z1P
'7
Telephone h4
Date DaM
1141-11
e�V�� (Revised 6118120 f2)

• k ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own. property adjacent.to - tTe_j0C_- Oki.,'s
ame of Property. Owner)
property locate at �N'$� . e
rr (Address, Lot, Block,:.: ad, ei�c.)
on : .P-0 a l� i� , in (,.N.C..
(Wateebody) (City/Town andlo ou
:j
The applicant has describ6d to me,. as shown below, the. development proposed at the above.
�
_ I have no objection to :this proposal.
have objections to this proposal.:
DESCRIPTION.AND/OR QRAWfNG OF AROPOSEa DEVELOPMENT:
(Individual praposirtg deiielop » nt must fil,1n* description below or attach'a site drawing)
e i3 +I�
13EC iv
JA N 12 2017 :
MIH® CITY,
1
(�tWAIVIi63
RSE-0 _a
understand that: a '`ier dbek Moodn `­`ilin s f reakw` t" r
p x g p g, a e ,boathouse, tiff, 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 wvaive.the sefiback; you must.initial the.apprQprrate blank below.).'
do .wish. to waive. W615'setback requirement. "
RECEIVE®
~ I do riot wish to waive the 16' setback requirement.
DEC 2 9 2016
(Property Owner Information) (Adlacerit Property Owner Infior"mation)
®CM.-MHDCITY'! ,
M
or T : e ame �^ I Print or Type Name ' 1
Nlai tng Ad ress iii
...
.� a ng res
-0 670
Ciiy/Stan .Z�p to It 2-
ClfylSfate/Zip 3 -
�7 l
To ephone Number 7'e/ephone Number '
1
bate Date t.
(Revised 611812012)