Willford, Charles

�7
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GE & I ELL
T 1 67084 A B (5,/ D
gFE PERMIT Previous permit # 0 ElComplete Reissue ElPartiall Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the'Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
S; Rules attached.
Applicant Name Project Location: County
Address— pot �J Street Address/ State Road/ Lot #(s)
City State, X- zip ('C 4
P,
E-Mail Phone# Subdivision
Authorized Agent City zip PJ
Affected L1 CW p
*A El ES D PTS Phone# River Basin
0 OEA L1 HHF El 1H El UBA El N/A
AEC(s): Adj. Wtr. Body/man /unkn)
❑ PWS:
Closest Maj. Wtr. Body
01RW: /yes no PNA yes ["'no)
Type of Project/ Activity
Pier (dock) length
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
Boathousel �oli I
- — t" II
Beach Bulldozing
Other
(Scale:
V T-S )I
MMMMMMIMMMMMUMMME MM
PIP
EMISSION I 1111111111111111111HE I
111-MMENEIRNMEN NEEN -
Notes/ Special Conditions
151
Agen,or t Applicant PrinteO Narne PermitOfficeP
,
ease read compliance statement on back of permit" Sigfiature
ADDlication Fee(s) Check # Issuing

t
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 0 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 comply with 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

AMR :e::::■:::::::::::
■::::■:::e:■:■ee:■::m:::::eeemm::::e:e:■
■■■■■■■■■ ■■■■■■■■■■■ ON rH=rr=1wr:�:■■■
:■.■■■.■.■.e.e......■..■..■..■....■. ■
Beach 8411dozing
■■■■■■■■■■■■1r ��■■�
Other—
■■■■■■■■■■■iiiililr■ ■ �
Shoreline Length V
SAV: not sure yes o '
Moratorium: n/a yes o
Photos: yes — Waiver Attached: yesno
A building permit may be required by:'�
( Note Local Planning Ju"risdictio ,
Notes/ Special Conditions 16e, '
/,'(i _�,,Tr3t7 S
Agent rApplicant rintedName Permito rc Pr
gna re m^�, (%er�ase read compliance statement on back of permit ,l Signatu/ree
lam' C
Application,Fee(s) Check# IssuingD e
i ONE 01
in
E] See note on back regarding River Basinxul es.
No
i
Ex imtion ate
2

I I
AGEN FOR PERMiT APPLI A i QNS
Name of Property Owner Applying for Permit-
Mai'linc address:
Teleohone Number:
ce�*, that I have authar'zed . 45 Lev
I
to a -It on my behalf. for "the purpose of applying and obtaining all CAM,,-',, permits
ne.-essary for 'Lr.,,,e proposed development of 0
at my property located at ZQ110
i-, �
This certificatior, is valid t., rough 1 ;2
(Property Owner info atom;
PifntoF Type Name
0'wnef- ar.y.,i.,stee for grope .7111,
W-------
I
7--57-- - 05-2W —
Telephone Number
Ema" Ad'...ihJJ
-
RECEIVED
OCT 2 3 2015
DCM- MHD CITY

11 -
ADJACENT RIPARIAN PROPERTYOWNER STATEMENT
I hereby Cerilify that own property adjacent to
(Name of Prooerty Owner)
properby located e, - 2�,0,4, 44/:?- 0 12644::�s
(Address, Lot, Block, Road, etc.)
on In
(Waterbody) (City/7own and/or County)
t
The applicant has described to, me, as shown below, the development proposed at the above
loctio,n i have no objection to this proposal
I have objections to this proposal.
DESCRIPTION AND/OR DRAWNG OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site dmWing)
" . . . . ......
RECEIVED
OCT 2 3 2015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, brealo�,rater, boat ouse, lift, onr%-AA- MHD CIT
rnustbe Set back a minimumn dis'arce of 15' from i-ny area of riparian access unless waived by
rre. (if you ly,;8h to waive the setback, you must initial the appropriate blank below.)
I do wish tC W2iV--'hC- 15' setback equirsment,
I do not wish to waive the 15'setback raquirernert,
(Property Owner Information)
Print or Type flame
Mailing Address
zo /'S
s a" e
nfalid f r one care-rdar year after signatuTe-
(Adja;66�rop4rty Owner Information)
-U414trnlf 8t &
Pr,:,,7,
or rvpe Name
9 A/l/ -�
Mafflng Address
lye-,
7a:!8.r,hone Nurqbe r 17" P 3c4drs

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby Certify that I own property adjacent to
(Adams of Prooertv Owner)
properby located at
a
Address, Lot, Block, Road, etc.)
in
on ge)444e �7M' Z NIL.
(Waterbody) (CitylTown andfor County)
The applicant has described to me, as shown below, the development proposed all the above
locatio e",
11�� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must 1711 in description below Or attach a sita drawing)
WAIVE SECTION ®CM -
I -understand that a pier, dock, mooring pilings, bcat ramp, breakwater, boathouse, IM, 01?oQ1TY
must be set back a minimum distance of 15' from my area of riparian access unless -.4v8ived by
me. (if you Wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1.5'setback requirement
—I do not wish to waive the 15' setback requirement.
Owner Information)
W#��MMEMYN�54`,
Frint or Type Narre
�6 //a -,IQIA62� leic)
11.4a... Add
lye-
3 53 - Z�-O t7t
Telephone Number/aiTail address
Dxe P
(Adjacent Property Owner Information)
A-4
Print or T, e Name
Y) YA JYWY, ZY
4,FZ- d:�U7
Telephone addr s-s
ZZ41 51-
2014)
'Valid for one calendar year after sigrature7

ConnectGIS Feature Report
Page 1 of 1
SCONNEOGIS Printed October Carte13, 2015
15
WEB HOSTING See Below for Disclaimer
Parcels - Updated 10-1-2015
Centerlines
NC Railroad Right of Way
13
CCoounty Boundary
Other County
<all othervalues>
Cart
PIN
Ncreaae
Parcel Cimersiors
Lot Number
RECEIVEC,
OCT 2 3 2015
DCM- MH® CITY
1 : 127 Feet
information displayed by this website is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and otF
lic records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for verification
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http://carteret.connectgis.corn/DownloadFile.ashx?i=_ags_map9659e75Oc5e748aO8de 116... 10/13/2015