Godwin, Bonnie

rAMA / ❑DREDGE & FILL 4') P� �� NO. 73369
E�iAL PERMIT Previous permit # A B /C 1 D
ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous per it issued `✓
As authorized by the State of North Carolina, Department of Environmental Quality 7 �—
and the Coastal Resour Commission in an area of environmental concern pursuant to I SA NCAC �••/
/� ❑ Rul s attached.
Applicant Name �' tl `C✓ i Project Location: County (� El
Address
City---_—�
Phone # (!-- 1 T O i
X I ' Street Address/ State Road/ Lot #(s)
State—C ZIP d- S 7 e% Uz
Authorized Agent V J "1 13 / + � C
Affected ❑ CW ❑ Ew ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHF ElIH ElUBA ElN/A
❑ PWS:
ORW: {yeA/ no PNA yes / no
Subdivision
City L.-' P/c � ZIP /
Phone # ()4 River asin
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Agent or Applit Pr4nted Narde
Signatyre \** Ple a read compliance statement on back of permit"
ApNicatkynTee(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:
J' Tar -Pamlico River Basin Buffer Rules J 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/ I-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)
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://portal. ncden r.org/web/cm/dcm-home
Revised 7/06/17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rm4 2ALZ> ? ^JS/7'/2
(Name of Prope�y Owner)
property located at �-/� �Y'�1 L7� �L �' ?.A 0 d u L- - et - 5 11
(Address, Lot, Block,LC
d, etc.)
on �j�� �L- j c u > in i . !Z 1-2r—R f N.C.
(Waterbody) (Ci y/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
I understand that a pier, dock, mooring pilings, boat ramp, -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 e_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow/ner Informatio r
Si tune
Pr' t or Type Name
Mrng Address
City/ tate i / �—
3 5 to 3 S� -2
Telephone Nu ber/email ad ress
o'h '. G re AlD 0 rPJ <' . CcAi
Date
o
(Adjacent Property Owner Inf?rmation)
r
S' nature *
.UI�1 GOAuJ,1�
P 'nt Typ Na e
�a en ��
Mailin Address
City/State/Zip
Telephone Number/email address
( �., t y RECEIVED
Date
(Revised Auy 461# 3 2019
"Valid for one calendar year after signature"
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNE.� NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #:�/ �" Y r Mailing Address:
Agent's phone #: _ f �J'r`� �� li P r, Ce apsf o Po 14 � f'✓/, 2 �✓r� �J
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A d�scnptio .or,=.drawmg u+yithd'irr�ens'ons rriust be -provided withth�s letter.
�I have no objections to this proposal. �4have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if Lou have been notified by Certified Mail
WAIVER 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. (If you
wish to waive the setback, you must initial the appropriate blank below.)
�k, l� , I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Z& 1i.� 66IJ
Signature j
Print or Type Name
?0 3&K G)
Mailing Address
/r4LA 275-7�
City/State/Zip
�/f 32O7l�{G
Telephone Number
� - 2,-
1
Date
(Adjacent Property Owner Information)
0
Signature
Print or Type Name
Mailing Address
City/StatelZip
2�7- , - -��/ fG�% l t-CEIVED
Telephone Number
/-Z -�-C,f2 JANp3/
Date
RevAG"HERCITY

'g,A w'!5oAl
C"VrL(
g�
RECEIVED
JAN 0 3 2019
DCM-MHD CITY

B P
SERVICES
228 Ocean Spray Drive •Cedar Point, NC 28584
910-554-0475
BILL TO:
DATE:
INVOICE #:
Quantity Description Unit Price Total
Balance Due

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ' f�tNN v e
Mailing Address:
'►,a, _&x' 15 S-e I'g), AC, 1 '7 > 1k
Phone Number: % r
r f
Email Address: ] b P► 9V e C PrI2
1 certify that I have authorized ��� �t �l�tD
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:��-
at my property located at % 0►� e j"=� I cf%q,�,,% T r c�% ���
in C1x4cl-<t County.
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:
RECEIVED
Y 60
JAN 0 3 2019
Signature
I r DCM-MHD CITY
DY1 yL ► G-0d w , Al
Print or Type Name
d 1-4 Line f
Title
t / 'k / I
Date
This certification is valid through I / ;�- / 1 e1