Ellis, Lisa

AMA / ❑DREDGE & FILL N9 78928 A B (C / D
ERAL PERMIT Previous permit# lJ
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality '7// / � ! i! /
and the Coastal Resources Commission in an area of environmental concern pursuant to i SA NCAC / l/ V
G 1 `/❑Rulgs attached.
Applicant Name �j �yf/ � r / � Project Location: County ✓ "1'r'�_.%
Address d� � / "? Of Street Address/ ` State Ro/add//L'ot #(s)
City r / ('J`' �`/ q StateA/� Zip V ) j t/ /
Phone # � 60V (41 E-M it Subdivision
//,� C.
Authorized Agent � Cr / / � ✓ � City F' / ZIP �r. F(� L
Affected -GTCW
eEW A! PTA El ES ❑PTS Phone# ( ) River Basin t /'`
❑OEA ❑❑❑p HHF ❑IH UBA N/A
AEC(s): Adj. Wtr. Body � `" '{ ` .rr� diaY /man /unkn)
❑ PWS:
ORW: yes / no/ PNA rye no Closest Maj. Wtr. Body t O
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Agent Applicant Pr' d Na a PermitOtficer s teN"-"--
ZS11gna,'""'Please read mm'pliadce 3[atement on backofSignatu(s)��t Fee(s) Chec Issuing Date
irat! Late

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 ❑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 howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Lisa Ellis
Mailing Address: 209 Mantle Dr
Clayton NC 27527
Phone Number: 919-606-6639
Email Address: lisa.elllsptarkett.corn
I certify that I have authorized Harber Marine Construction
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Install a hogslat dock
at my property located at 482 VFW Cedar Point NC
,
in Carteret County.
I furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management state, 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:
j Signature
Lisa Ellis
Print or Type Name
Owner
Date
Title
This certification is valid through 12_l 4 l 20

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Lisa Fllis ,s
Property located at —482 VFW Rd (Name of Property Owner)
on White Oak (Address, Lot, Block, Road, etc.)
in Cedar Point N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to ation,,7
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. (If you wish to waive the setback, you must initial the appropriate blank below.)1.
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Liu Ellis
Print or Type Name
209 mantle Drive
Mailing Address
_ Cedar Point NC 27527
City/state2ip
Telephone Number/email address
Dare
'Valid for one calendar year after signature'
r.T,
Property
F
telephone Number/email address
(rj U 4l a lr9t lt&,Zi ur!
Dare•�SlaoD.
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to Lisa Fliffiq 's
property located at 482 VFW Rd (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on White Oak in Cedar Point N.C.
(Waterbody) (City/Town and/or County)
The appliCan ha scribed to me, as shown below, the development proposed at the above
lo, ti n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developmerif 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I d wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (A "cent P ogie rty
O ne f illo
Signature Si �Qto(�
Lisa Ellis g, 2'a �4ks
Print or Type Name Print or y Name' O
209 mantle Drive
Mailing Address Malting Addre
Cedar Point NC 27527 o f_i 7^SS 3
City/$tate/Zfp City/St��tte/Zip ,. rr�
..919-606-6639 `1I A - ©S" Q8A4
Telephone Number/email address Telephone Ifumper/email addrep
Date Date* �- C1u�� �, (U ran
(Revised Aug. 2014)
*Valid for one calendar yeaafter signature*

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