Williams, Danny

MA 4DREDGE & FILL
JVO
A B D
ENEFML PERMITYY Previous permit #
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 Resources Commission in an area of environmental concern pursuant to 15A NCAC
d-
7 Rul6s attache
e cation: County.(
Applicant Nam Project Location:
Address k r( Street Address/ State Road/ Lot #(s)
City
State zip 1) 5,
Phone # E-Mail Subdivision
'IN
Authorized Agent I % city JI ZIP
El Cw bow "A DES 0 PTS River Basin Phone #
Affected -1 N/A El OEA El HHF 91H El UBA E
AEC(s): Adj. Wtr. Body' .,
nat /man /Unkn)
0 PwS.
Closest Maj. Wtr. Body
ORW: yes 4-no PNA yes (no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier s
Groin length
,�.I(nuolber
h4d_.Prap length,�kl
ayg distance offshore
max distance offshore- .�5 1
Basin, channel
cubic yards
Boat ramp ---
Boathouse/ Boatlift__
Beach Bulldozing'
Other
Shoreline Length
SAV. not sure yes �no
Moratorium: n/a yes (no,
Photos: yes Ynoi
Waiver Attached: yes flno
A building permit may be required by:
(Note Local Planning jurisdiction)
Notes/ Special Conditions
(Scale:
,A) 6( El Seenote on back regarding River Basin rules.
1 V\z 1-w-1 �'ti'r� r r /vf i� 1 r j,�t /
Agii or App#cAnt Frinte . d Name PermitO
SignaturePI ase read compliance statement on back of permit" g
Si natun
Application Fee(s) Check#issuing
N I N�
cer's'Printe Nime
to tii 'Mi'

t .A
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:
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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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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►�Permi't4l".,ticer's Pig
s compliance statement on back of permit** Signa ure

North
Carolina Department of Environment and Natural Resources
Division of Coastal Management
Fiat McCrory Braxton C. Davis
Governor Director
Date q • �� . 15
Applicant Name TA n n Y L J. l l,� m s
Mailing Address `f)y-ON 2C-1—o
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) N L p B-4 Z-3 to act on my behalf, for the
Purpose of
applying for and obtaining all CAMA Permits necessary to install or construct (activity)
at (location)
Ar)
This certification is valid thru (date)
Signature
RECEIVED
NAYA77015
RECEIVED
MAY 1 1 2015
CITY
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net NOrthCarOhna
An Equal Opportunity 1 Affirmative Action Employer

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 0 LJ ( I I i is wt 5- 's
(Name of Property Owner)
property located at
(I k I kr-5a- 1, Al --k:5
(Address, Lot Block, Road, et
on �A 1n—�4 in W- L 4,4 �c �jC:�A G 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 roust fill in description below or attach a site drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, o,�,�oin����
must be set back a minimum distance of 15' from my area of riparian access unless waived i�7
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
MtiJ I do wish to waive the 15' setback requirement. �!1PECEIVED
015
I do not wish to waive the 15' setback requirement. MAY 112015
MAY
�a
(Property Owner Information) (Adjacent Property Owner Information)
rS
at zee
Print or Typ Name
l o3 pnow-Z L,-- oa0 6 aaT—
Mail ng Address
ly . 21S C `6
City/State ip
<:1 t o "z-Ct
Telephone Number/ email address
q.--�ti 1)5
Date
*Valid for one calendar year after signature*
Tvbe Name
M Anddres 2�� l Z
i
Ci y/State/Zip
Telephone Number/email address
Date *
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J AR14 N w w ► Vn s
• (N me of Properly Owner)
property located at
(Address, Lot ck, Road, etc.
on 4fA Y'J 4 L- in rq rVd-Lr- �,a vI 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 fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
must be set back a minimum distance of 15' from my area of riparian access unless waive 40 7
me. (If you wish to waive the setback, you must initial the appropriate blank below.) 6'4-' 9 z�TS
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)
&&'2tA k& .
Si natur
Print orT,��ppe Name
Magi Address
Al:!-
Cit State/Zip
Tel phone Number/email address
'�o ,1S
Date
RECEIVED
MAY 1 1 2015
2,F.5'L z
Telephone Number/email address
5^'15 /S
Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature*