77294_Shane & Ami Staples_20201019

2
• CAMA/ EDREDGE & FuL9 (4, j SNo77�P� fl Previous permit# +,J 4
�� 2New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N!A
As authorized by the State of North Carolina,Department of Environmental Quality `1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC M , ZOO
lYfules attached.
Applicant Name Shari 4- Am% Ckaples Project Location: County 15E* ico(tT
�"Address , LI K 1`r by GI'G'iN C 4jC Street Address/State Road/Lot#(s)I
City "e)oC}'1n State V3C ZIP al..+D¢$ 144 K i fb c r5 t kvt
Phone#(ZZ)415- -QS?E-Mail Subdivision 414
Authorized Agent )J )74- City ZIP S12s3
Affected ❑CW ❑EW [? rA El ES ❑ `t PTS Phone# ('-5Z ) qs Z
- 3 125RiverBasinTIM)P4W1
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body AC. K e-✓
ORW: yes /� PNA yes / no 1�`ar`J Closest Maj.Wtr. Body FA)11(Z'GO \fGam.
Type of Project/Activity Pr a Top Sep &.,4sk r u t,}-Ior O F I xj)( 13 bac kV - w;- c,
5( X p (-1 )fit v i f p)P( (co,r►s; c.rc* -014k ca- , ) (Scale: I'. - 416 ' )
Pier(dock)length i
Tit , , . . , ,Fixed Platform(s) 3 X a
jhIs
Floating Platform(s) ! i i !
Finger pier(s) ii.
Groin length
I
number —.T._.._._._.._..;..._......;- �...... -.ice_..._._._ — —--—...._—.._...._.._........
rit
Bulkhead/Riprap length i tar 1 I
avg distance offshore\ 1 1 1 AI I
max distance offshore JI
Basin,channel — A, : k*1.- -ram
cubic yards �'
Boat ramp .49
Q I'
Boathouse/CP !3 x '� - - I ... + . _.__.. ..i _--_
I�
Beach Bulldozing 2 t ! 1
Other &I'l vf41 IV : :
\ + E
Shoreline Length Z b0 i=
SAY: not sure yesL 1 • 11, rLA a I
_..........4 , 1 An` .. Th
Moratorium: n/a yes ® F WICET .lr
Photos: yes �o —_Q�. ' % I PROP` d .._...
Waiver Attached: es i i E
Q.
A building permit may be required by: 0 fr4N 0C 'M7 !} . IVI See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) \\ I
Notes/Special Conditions K.Ci rl S MA\ti ti e� U \Au.) w 14,, go .;Kw kfeeS. pli(.ayk
x);11 (.A in, 52.b.c4'1 ,vk 4116r 4 t)kvA SOO C 2• "T't-' D T- 3 or- ...1
S(., r,, . r ( -/ /cJ EL. ��'/✓t y
Agent or Applicant Printed Name „ Permit cer'S Printed e
�
,,, mac'_"_ .,'s --'' I
Signature **Please read compliance statement on back of permit** Signatur�J `,err'
e�(L 11 k "Z0C7 % J/3 3 I cl o�-r+ ,,,--2 "%..v f -F->z,.„J1�Li '.LOB.)
Application Fee(s) Check# 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 I)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 (252-946-648I) or the
Wilmington Regional Office(9 I 0-796-7215)for more information on how to 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 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

r- - --,.''—iimil7m°.".1 ' .—' .."'""11.1 ----.7 F41.1:-.)
❑CAMA/ ❑DREDGE & FILL LiN° 77294 A C D
GENERAL PERMIT I5Pl Previous permit# I
)G ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued !J/A
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 5A NCAC 11l , I (DC-, .
tt 1 ,Aules attached.
��``
Applicant Name 711AVNt~ �r �jnv,t si�'?le 5 Project Location: County 7,,.1-Y1ve r 0(L'►
Address \/L! \ ! by e s°OY`C3t 4JC Street Address/State Road/Lot#(s) f
City 't, \-1 State OL ZIP S a S t -`t , r'o7 [.;.,rua�`‘y( ILI*'
Phone#(7'L) `11 • "-4{' 7 E-Mail Subdivision 141A
Authorized Agent 1. j 1 4- City e:."cl^ ZIP : -I S(12 S
❑CW ❑EW [I'TA ❑ES ❑PTS Phone# ('57 ) `I IC - 3? Z- River Basin'T4' )P411,1
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body . (.,IQ )4 (hat at /man /unkn)
❑ PWS:
ORW: yes / no PNA es / no Yh�a Closest Maj.Wtr. Body 'AYr L 0 P-.y,J((-J-
Type of Project/Activity -e- - c Se, (.r)Yl tut 'luv' i * w ''r
g Caw ems,`c(r:° �1ai(t,t n-) (Scale: I 1 `.1'' )
Pier(dock)length
1�// I
Fixed Platforms) X "1 di. •'} [4
Floating Platform(s) El' 1
Finger pier(s) °%u �._
III 1......... �
Groin length i
number i .._I -
.. .. �..� - .____..._ t - ...
Bulkhead/Riprap length
— • { _ I
avg distance offshore -- ' .+_
max distance offshore �`. Iix.1
j
Basin,channel l i i I
I ' ' y-�,S 1 , 4
1vIes. 1 1 1
1 A^
: ; :
cubic yards I tl �"'1 I
Boat ramp M. 1 -t- AI ?
s
Boathouse/Boatlift %;?( ' — — IL;
Beach Bulldozing
I
Other t �f
1 Mi
11111
%{ it 1111
Shoreline Length2 b {i i it }` E
SAV: yesQ - ._--- — \ ..�... ._
T
not sure o -:-----
lk
Moratorium: n/a yes 1 t u__I-. ... ._._.._ 1. !1.'...:.��C !
Photos: yes no`: — .._. .. +� ?' �... 1............i ._ ._.._ j {...._.. ........... __
..17'..t or ..
Waiver Attached: (y (ri5` '� ... _ 1 i t I i
�` 1?_ � —5/
A building permit may be required by:I l.4'' 0 3, 4 . VI See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions l„„e! t .N-,n lr_.- ''^y'. ‘,•-4-a t.o. `-+ .. ca. CO.".'-' 4r ee S. Y Ye 1i't)11 U
1
-1
Agent or Applicant Printed Name PermitOfficer'(rinted e
-7r--
Signature **Please read compliance statement on back of permit** Si\turd / -^—
i,,,i - i1 k ? CSC.) f.:1- //3 l `''} o,--tt>.,c rL -ZOO,..., 1~i Fell, ,4x t -t _2_0`' 1
Application Fee(s) Check# 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 I)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 (252-946-648 I) 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 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- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

c
TOWN OF BATH
BATH, NORTH CAROLINA DATE /0 - / - 2-0Z6
rs
BOOK NO. PERMIT FEE �D— PERMIT No.
APPLICATION FOR: BUILDING PERMIT( ) ZONING COMPLIANCE CERTIFICATE ( X )
Name & License No. Address: Phone No.:
OWNER ��uh d�,,. S� l ) /7Y /:r% 6,�<�f�
CONTRACTOR
DESIGNER
SURVEYOR
ELECTRICAL
PLUMBING
TYPE OF IMPROVEMENT
NEW ( ) ADDITION ( ) ALTERATION: INSIDE ( ) REPAIR: INSIDE ( ) MOVE ( )
OUTSIDE( ) OUTSIDE ( ) LOCATE ( )
Lot No. Block No. Building located at /7(7 , •r/oy i^< �+fYG
between and Streets. Building to be used as
. Type Construction rer/<•t e i e//11 .� '„j,� P,�,r
Number of off street parking spaces . Contains rooms and bath(s).
Total square feet of building Electric Servi
Type of heat
. No. of plumbing fixt s . Foundation block caps
4"( ) 8"( ). Corner bracing: Plywood ( )other . Insulation: Floor
Walls , Ceiling . Windows: Storm ( )Thermal( ). How many exterior doors
. Water Heater: Gas( ) Electric( ) Other
Roof Ventilation: Gable( ) Eaves ( ) Louvers( ) Other . Ventilation
crawl space, number of feet apart . Height of crawlspace under house: 18"( ) 24"( )
Other . Zone . Water and Sewer Tap: Paid( ) N/A( )Size water tap
Size sewer tap: . Total Estimated Cost Flood elevation
c L
6

BUILDING INSPECTION DEPARTMENT COMMENTS:
•
—PLA! t S S 140 oni p F A /'V F_Lc)
75/14 i L I P 1
Ey./STiJ0G 1_064i-i'7eA.t , I ol (vinF'
¢E l P G,[-E1c 6d -ro 13 1, f=r lit 4 1A r w e
4D:Tu5 -7-zo re 3 ' hZ'- '• S 6-775 Aocs 77 or RA
I�TAr_ D F 5 L/I
GENERAL COMMENTS:
CITY LICENSE NUMBER:
Contractor/A electrician Plumber/Heating
Application approved by: /�_ �_2-400-0
The owner of this building and the undersigned agree to conform to all applicable laws of the Town
Bath, North Carolina.
Signature of Applicant
Effective 8/10/04, there is a $50.00 filing fee for all permits, including zoning compliance application.
Any construction that requires installation of water or wastewater services may:
A) Be installed by owners, contactors or
B) Be installed by Town of Bath Utilities Department
All components must be compatible with existing water/wastewater materials, including Myers pumps.
Bath Utilities Department must inspect all construction prior to services becoming operational. Inspectio
fee is $100.00.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S L c o c- 4,, S/v 4 s 's
(Nam9 of Property Owner)
property located at l 7 (-/ K h7 (� r`c n s ✓�
/ (Address, Lot, Block Road, etc.)
on /���-k ��c�G , ina f , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio�t
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)
�,✓ ^�, P� r over/tide.
ver
pia%vs
/J
0 0
0
AL-f
14,4
I-
iv/no/I- v
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.)
ijj I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propertyy Owner Information) (Adjacent Property Owner Information)
ne- W-r//tcPrilY
Signature sI / Si514, R* 4
cnc- rL�/GS j-f�, R. � -S
Print or Type Name ///--- Print or Type Name
Mg Address Mail Address
ailiJ// ,�° ,27dt8' I ' e. c')' /7 ff
City/State/Zip City tate/Zi
- 17 9S-37 4.5 III IC. 2 7 8'c?
Teleph ne Number/email address Telephone Number/em /I address
9 -z.1/40 a5A. 92 3 Y45r450
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT J f
I hereby certify that I own property adjacent to 1, 4 n 6 4- Si c,ol_S 's
/ (Name of Property Owner)
property located at I 7L/ rh7 61 e Ate-
/ (Address, Lot, BldsckkRoad, etc.)
24 on le:,‘ c k , in /-s /-. , N.C.
(Waterbody) (City/Town and/or County)
The applic t has described to me, as shown below, the development proposed at the above
location
1 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)
Rif lc ews-Ak� k�oci.. i /�f p� hec4f sk Arct;.,
L---- 1 t-
NSnnY So
4
cI f
1111 ' ow I.7,/l .fig: /1/- ,� -2Sv 41 p:.�r-
v A o r
Aif<,i s A 51 .1e.
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner In ormation)
Sig ure , T / Signature
Print +431----
or Type Name Print or Ty N,r e
/7Y k r4, 6r`c•-•sc Ai , U e,A., `tc-
Mailing Address Mailing Addre
/J 2 /1/C a.27fOJ ?� -.2%2e.6g-
City/State/Zip City/State/Zip
-232- v9s- .77O2 �2' Z3'L��
Telephone Number/email address Telephone umber/emai address
Date/r2/�U Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*