Pittman, James 73296C

CIWA / DREDGE & FILL NO. 73296 A B C D
9�ENNEFLALL PERMIT Previous permit #ew ]Modifiication El Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an -,area of environmental concern pursuant to I SA NCAC
[ Rules attached.
Applicant Name 1 Project Location: County `
Address Street Addre s/ State Road/,Lot #(s)
City �' State IP
Phone # �:r ��E-Mail Subdivisior�� � „_ 1 (�✓ T—
Authorized Agent City
CW T-E A ❑ ES PTS PhoneAffected ❑ OEAF //❑ I��H ❑ US ❑ N/A
AEC(s): El PWS: Adj. Wtr. Body
47- Closest Maj. Wtr. Body
ORW: yes / Rio PNA yes / �o
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Signat ' Pleasq read co liance statement on back of permit
Application Fee(s) Check #

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 ❑ 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

JACENT RIPARIAN PMERTY OWNER STATEMENT
;ertify that I own property adjacent to .J AM& ►a/. �)i ; T/'rth i� s
(Name of Property Ormer)
(Address, Lot, Block Road, etc.)
on 1AYf} S in tom£ N�� r Ck� (' Ja T L 7 N.C.
(Wafts ody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
` See below I have no objection to this proposal
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(!ndlvidual proposing development must fill in description below or attach a site drawing)
SLE FU-\N
` have no objection to this plan contingent on the following understandings
1) The area east of the "Main Dock" is not a boat slip and
2) 1 am waving my 15 foot setback only to 11' per the attached drawing and
3) 1 am waving the four foot (15-11) only for this plan design.
WAVER SECTION
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. (tf you
wish to waive the setback: you must Initial the appropriate blank below.)
` See abov
Fdo wish to waive the 15' setback requirement
1 do not wish to waive the 15setback requirement.
(Property Owd?information) (Adjacent Property Owner Information)
Si hve ;}}
1AMC:- 4V` Nl rdj t�; t
Print Type Name
A L� 4 y Print or Type Name
MalNra9 `t PL-CACAW7 -Rk ME K�
LLAd IV C � 7 � � � Marling Address -- —'p
city/state/Zy _(,., G� 3 Cj
2 -) z 4 5 _ G, � � c� Gty/State2ro `
Telephone Numbs
r
telephone Nurnbar
�o/�� RECEIVED
c>are - ---__
Dare
OCT 03 2018
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATINgNT
I hereby cerd' y that I own property adjacent to . J Atli v � r -r�,
s . (Name of Property Owner)
property located at l� �' liJ T' T
(Address, Lot, Block, Road, etc,)
on i ;1� 5 Ci�� in E-Ru FO T r Ae i f , N.C.
(Waterbody) i (City/Town and/or County)
i he applicant has described to Me, as Shawn below, the development proposed at the above
IL
I have no objection to this proposal.
I have objections to this proposal.
DESCRiPTION AND/OR DRAWING OF PROPOSE© DEVELOPMENT --_
(IncHvidual proposing development must fill In description below or attach a site drawing)
SEE'
WI ACTION
I understand that a pier, dock, mooring pHings, 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
l do not, wsh to waive the f 5' setback. requirement,
itPropsr4y onuatlon) (Adjac eat Property Oner l aglon)
Si e iJ Sf
Print or Type Name � C-
�� Pant Al,
1,ia1Hng Address `�
i� �- l4ra111
A/0
ity/StatelZ RECEIVED
7"eibphone 111ur»bsr 7eiephon Nunn r
Date ----bCM-MHD CITY

Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
CA LV'-
\V,
�5 a - a L45 - b� lD
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
411, e ulc-�-e__ N-,e
at my property located at \llcj� �� 0�.�7 ��" dt
in County.
C om
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:
Signature
Print or Type Name
Title
C _I ` l\4%
Date
This certification is valid through I I
RECEIVED
OCT 03 LU18
DCM-MHD CITY

r
. ..... .................. ,
RECEIVED
OCT 03 2018
L117i i 'I I
D
CM-MHD CITY
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