Wilson, Alice E

OCAMA / REDGE & FILL
G,..t,ENE L PERMIT Previous permit#
L New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
f.
As authorized by the State of North Carolina, Department of Environment and Natural Resources �� r , }^'
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 1f,t-1` 11 c�� ` • . /tt_ 1( U
Rulules attached.
Applicant Name Project Location: County t,�•'� ` s•
Address . '�( ' Street Address/ State Road/ Lot #(s) i
State 1 IP
,city
Phone # ""i� Fax Subdivision' r ,
Authorized Agent
ElCW
EW bZPTA JES El PTS'
Affected
AEC(s): ❑ OEA
❑ HHF ❑ lH ❑ UBA ❑ N/A
❑ PWs:
❑FC:
ORW: yes / no
PNA yes / Rio Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
I". .A.,
Finger ier s / C
Groin length
-number
Bulkhead/Ripraplength
a g distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure y yes Siino
Sandbags;' not sure yes a
Moratorium: n/a yes
�'
Photos: yes
Waiver Attached: yes no ' \ j
A building permit may be required by: •.j \Vt I
Notes/ Special Conditions
`Pl~(�?
City '1-4-1 t.i ; 1(
Phone #
)(l Wtr. Body > ,
Closest Maj. Wtr. Body I"
* /, (\-I t,�l
ZIP
River Basin`-i. l
(Scale. )
i i
❑ See note on back regarding River
A
ig Dan�te
t /
signature
} l ' .
Exp
indiction T Rov
n
,n Date
e Name
i

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
❑ Neuse River Basin Buffer Rules
❑ Other:
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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

Applicant:
s�
Date:
i�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated. final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp Impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
)Dredge ❑ Fill ❑ Both ❑ Other
edge ❑ Fill Both ❑ Other ❑
0c)
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ' ❑ Other ❑
Dredge ❑ 'Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
vWASsA. 02103M 0

12_rMa r. 18 201.3 9 27AMutl c Leta Morehead • 12. 27260221'• To:12528O95--"— 52 P, 1Age:2/2
North Carolina U.Oadmant of Environment and Natur il Pes'ourcas
Division of -Coastal. Management
Pat McCrory Brexton C. Davis John E. Rvaria, III
Govemor Director.' Secretary
Applicant Name �1' ��- tj ! �
Mailing Address__--
�I�ar"o�
i certify that i have authorized (agent) O(C6 rZny to act on my behalf, for the
Purpose of applying for and obtaining all CAMA Permits necessary to install ox construct (activity)
,S at W 01 �i(7G�C , at (location)
Zito Ljw 14 f 104e— becek W-,- Zf(SIZ.
This certification is valid thru (date) 73 r`(
Signature k � %
400 Commerce Ave., Morehead City, NC 28561
Phone: [phone] FAX:[phone] Intemak ww►r.nccontafmanagement.nel
Art Equal 4ppodunlfylArro�maGveAcGon Employer
NorthCaw ' a
atut'

ADJACENT:RIPARIAN PROPERTY OWNER STATEMENT
(FOR A. PIER/MOORIIY_G PILINGS/BOATLIFI_YBOATIIOUSE) -
I he certi f that i-own ro ert ad'acent to C f G�, 5 v ^ 's
-y_ y - p p y J- -- -
-- - (Name of Progg1y Owner)T
property located at _
- a
- T(Lot, Block,- Road,
_ -
oft in
- - (Waterbody) -- (Town and/or County
He has described to me, as shown below, the development he is proposing at 'that location;
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
AnAQ wish to -waive that setback requirement.
--------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
S RECEIVED
MAR 15 2013
DCM 1'4HD CITY
------------------------------------------------------------------------------------------------------------------
e5ignatur
Print or Type Name
<<y_��2 �6�iN
Telephone Number
Date: 3

L
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Out
RECEIVED
MAR 15 2013
DCM,NIHD CITY

ADJACENT" RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C
-- - A - _ (Name of Property 'Owner)
property located at
(Address, Lot, Block, Road, etc.)
on oa i "L•� _cam_ , in e"Cr 'jle-C.Zl YUC 2!(S IZ , N.C.
(Waterbody) (City/Town and/or C•ou. nty)
The applicant has described to mc, as sF owo t►elaUf, the daveloprne�-it proposed at the above:
location. / k I fn
i/ 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)
5a �
RECEIVED
MAR 15 2013
WAIVER SECTION DCM-MHDCITY
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.)
I do wish to waive the 15' setback requirement.(-,"
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjace ntR rope rty Ow er Information)
zx� �, 4JAI;-J �A � ) d. U&, YZ
Signature Signature
—� Zo
Print or Type Name
v is 64 LSD/
Mailing Address
Tcr00ra Wt, 27616
City/State ip
zsz- b3y35
Telephone Number
,�--Iq-15-
Date
Print -or Type N me
2 -3 " ((� eiJ e Li
Mailr g Addre , `� G Z
f7 � r°�k z
City/State/Zip
Telephone Number
Date
(Revised 611812012)

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RECEIVE)
MAR 15 2013
DCNI-MIM CITY
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