Sanders, Greg

/ `9r61AMA / ❑ DREDGE & FILL N° 78410 A B c D
GEFN PERMIT Previous permit# 5
Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by th State of North Carolina, Department of Environmental Quality
and the Coastal Re)oLWces Commission in an area of environmental concern pursuant to I SA NCAC
f� ❑ les attached.
Applicant Name j6 /r'� �G r�P fs Project Location: County IJH L
Ci �- .-- State
P�Z�—' � Address/ State Road/ Lot #(s)
Address ,� V y a/ I. Street Add 4-
Phone # (A% 7r'E-Mail Subdivision
Authorized Agent
Affected p2w o.EvOfli
AEC(s): ❑ OEA ❑ HHF ` ❑ IH
❑ PWS: /
ORW: yes / no PNA yes I no
Type of Project/ Activity
Pier (
Fixed
Floati
Finge
Groir
Bulkf
Basin
Boat
Boad
Beacl
Othe
Shon
SAM
Mon
Phot
Waiv
❑ ES ❑ PTS
❑ USA ❑ N/A
City
Phone # (
ZIP
River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr.
50
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A building permit may be required by: ,) 1 h/ L,
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( Note Local Planning jurisdiction) J
Notes/ Special Conditions / _f (� -)
❑ See note on back regarding River Basin rules.
PermitOffcer's Printed Name
Signature
i )r��l"1�
Issuing D� e ' pirati o n 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 El 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/ 1-888ARCOAST
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)
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.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C re-11 9r) i co I S c),(N .rS 's
[� (Name of Property Owner)
property located at 2-16 E-Ml- Ton (1 P 1 A a 2 R D
etc.)
on Cree K in
(Waterbody)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
locoon.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ondlvldual proposing development must Hll in description below or attpch a site drawing)
/ I sF-r f r. U o
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WAIVER SECTION
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1 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.)
ql' o"O tl
b t-1 {fowi
z t-1 q Pr-pvr-hy L,nl
ci woc* e. s e`J94
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signalure
C.ceu "�o,.�c rS
Print er Type Name
.216 r
Mailing Address
NL•befi NC 2KS3°7
City/StateMp
7ro - ii 1'�-S`7 CA 2
Telephone Number/email address
701q-1L-VI
Date
(Adjacent Property Owner I formation)
Sig` �n�77aiure'
Print or Type Name
2'tN Et?i✓6.,' P�
aMMailing Address '
.N� 2Bs3g
City/State/Zlp
H1.1. vh- eaz-
Telephone Number/email address
/715/ze/7
Date"
(Revised Aug. 2014)
-Valid for one calendar year after signature*

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: 216 E T u y % Pr DC F—
(Lot or Street #, Street or Road, City &
Agent's Name #:
M
iv` (` Mailing Address: $O (
( RE6 K
Agent's phone #:
ZS2- 7 6
r4 1gyz a1� 1�6ov,)
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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 description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have 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 or receipt of this notice. Contact information for DCM offices is
available at htta.//www nccoastaimanagement.neUweb/cm/staN-listtnv or by calling 1-888-4RCOAST.
No resoonse is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
1 do not wish to waive the 15' setback requirement.
(Property Ovfner Information)
Signature
Print d Type Name
2146 E T l/YI-,;, E K
Mailing Address
1 &C 2,g539
ty/state/Zip
?6o-sas-s�� Z
Telephone Number/Email Address
Date
(RI r' Pfd ert ner Information)
7f
Signature
an Wo.I+m^n
Print or Type Name
q1 A- Po�9
Mailing Add ss
CPIPMIAI N5 D�6
City/State/Zip
2.12 WZ ter qO
Telephone Number/Emait Address
7- vec-
Date
(Revised Aug. 2014)

Davenport; Ryan
From: Robert Jackson <[e-mail]>
Sent: Wednesday, December 11, 2019 2:57 PM
To: Jim Johns
Cc: Davenport, Ryan
Subject: [External] Re: Bentley Brooks acting agent for Robert Jackson
Ryan - I hereby authorize Bentley Brooks as my agent in lieu of JoAnn Mangum to pay for the permit. Thanks
for your prompt attention. r/Bob
From: Jim Johns <[e-mail]>
Sent: Wednesday, December 11, 2019 2:08 PM
To: Robert Jackson <[e-mail]>
Cc: [e-mail] <[e-mail]>
Subject: Bentley Brooks acting agent for Robert Jackson
Bob,
Ryan and Bentley was at the property today,
Ryan has your application but needs you to send him an email assigning Bentley as your agent to pay for the permit and
have it issued for you.
Thanks,
Jim Johns

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