Gladwell, Bellie and Charlie

- CAMP I DREDGE & FILL
CEN =:RAL PERMIT
Jew I Modification Complete Reissue _Partial Reissue
As authoritLed by the State of North Carolina, Department of Environmental Quality
C area of environmental concern pursuant to 15A NCAC
No. 73135 A
Previous permit #
Date previous permit issued
B C D
and the Coastal Resources ommission ;n an
❑ Rules attached.
A li—t- Name - } '- �J � � Project Location: County _ ) - -- L ��
pp
Address
XIOIEV
7"
Phone # (_ _) )
V
E-Mail
Authorized Agent
❑ CW
Ir—_ EW
PTA ❑ ES ❑ PTS
Affected
❑ OEA
C HHF
IH ElUBA ElN/A
AEC(s):
ORW: 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 lengt,
avg distance offshore
max distance offshore
Basin, channel /
cubic
Boat ramp
Boathouse/
Beach
Other
Shoreline Length -
SAV: not sure yes ho
Moratorium: n/a yes fmo
Photos: ye ono I,
Waiver Attached: yes *no --
A building permit may be///required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
7r"1,.'A 6 sOf A/A
Street Address/ State Road/ Lot #(s)
171) t- Fj /
Subdivision /
f 1 f ZIP
City
Phone # O River Basin
Adj. Wtr. Body _ (nat_ /man unkn
Closest Maj. Wtr. Body
(Scale:.')
j I
w� ! % E ❑ See note on back regarding River Basin rules.
Agent or Applicant Printed a
At
Signature Please read compliance statement on back of permit
Application Fee(s)
Check #
Permit Officer's Printed Name ,f
!
Signature
Issuing Date Expiration Date /

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
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 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/ 1-888ARCOAST
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

)Wj' viai ve'k�
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
PARCEL ID: RECEIVED
STREET ADDRESS: r '� v O C T 1 7? U i
, �� A`- AJ- c- DCM-MHD CITY
Please print: � tt>
Property Owner: ` � � �� CI�'�/� 41 IF
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
7or+, G,ncaN.,S JS:L S'ry., 19
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
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Telephone: Z; S -Z z'-z- `L b 97s
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
S r oP40 Qhn'I-u
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Authorized Signature Authorized Signature
Date: r Oh&,/& Date:

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of'Provertv Owner)
property located at L * 2, /6 t� L`
(Address, Lot, Block, .Road, et .)
on 050C �J � in Cr w.r�-�' aa�r N.C.
—T(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iota
X,, 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 groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (Ifyouwish 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 Informattiio�nj)�
(Adjacent rty Owner Information)
//�J
Signature t /��
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Signatur
/) . /1. f le3wc -
Print or Type Name
1( � � ti '
9 s
Print or Ty Name
4319 diccJ 9111W
MailingAddress / 2
M=rPs3eack,(/^�c /vC GO��2
City/State/Zip
�sL 3� tb'r�
City/Sta'ip
?�2-23o
Telephone Number/_email address
Telephone Number/email address
/±
il
Date
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

To Whom It May Concern:
We authorize Tom Gurganus to act as agent on our
behalf to secure any necessary papers for LAMA.
Our property address is 132 Bayview Dr., Atlantic
Beach, N C 28512
Charles C Gladwell
January 7, 2019
t
Billie V Gladwell
January 7, 2019