77431_Elizabeth Penhollow_20201026

__ s
tyem�CAMA/ O DREDGE & FILL z046713# NU 77431 ABC D
NERAL PERMIT Previous permit# t.1
FIEp /b
New OModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 01 iQ
As authorized by the State of North Carolina,Department of Environmental Quality -7 J
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 71-1. 1 Z
Applicant Name E l l Zo•b e ilgRudes attached.
}fin Pe....,-An Project Location: County �je�,,�-�'pv,k
Address 2 y \ "rreo,..5,,e_ 'C''pw, 'Dr. Street Address/State Road/Lot#(s)
City $A t
l State t ZIP D Og i3 y1 T,ceQSt,t 'Poi i.-ic 1>c.
Phone#(25Z)`?c13-5c539 E-Mail 1De:1-1 ,ptrtim110“yiS'nc46bts,C,rSubdivision -T-�cks eg-e. tat
Authorized Agent " "-'$'5 'AA orr-iy .€. _et>1,164- City 'Bec\-\ ZIP .P-3-5g 0
Affected D CW DEW V' TA DES OPTS Phone# (ZSZ) (05 tf 1. River Basin 7-41K f Ply
AEC(s): D OEA 0 HI-IF D IH ❑USA ❑N/A n
O PWS: Adj.Wtr.Body Hervey tX+2G CD/man unkn)
ORW: yes / no PNA / no =�`�„`� Closest Maj.Wtr. Body 1Q. Yt UGC) '] .i s/bC
Type of Project/Activity i?r.pe,Se cons*tcilorl Der 4 j(S0' Fier cui4 /is,X20 olfv ,
MDx/1 covert of 132c13 bea4-\4k Alt i) (,X 10'flcr 6}Clir . 6.4 puce coed-bet wwer.i'(Scale: 1n y')
Pier(dock)length 80'x b
i r 1 i r . r— -
TT _ _ _
Fixed Platform(s) J10 ( Z c { -I,. ..__ {
a �_ �.. yI�RV-� 4.r4a-K � ; , 3 ..
Floating Platform(s) ; _... - s
Finger pier(s) + { - { } 1- h } - i V, 1 _ _ ._
Groin length _J. I _f. i. I i F j ` p 1k 1-- 4 ; ,-.1
number I \I �> xa • I 1T �--.F1 It -,J�b -1.7 Il _ i-
8uikhead/Rl length 1 J(-I3 _ `��!L �+ i_ -� I. i `1_
i • -
Prep � , - I � i 1 �p ; - - .._�
j h _ .! 1Lavg distance offshore , i - -.max distance offshoreliI t f I 1 --
Basin,channel i ;.._ _j i , ,
-- i f_ --- -j 4 I- - - I � a ' is ,r, r .-._�
cubic yards -..1-,_ .-� _ _ 1 I -
Boat ramp \ -F T �_{ - t t t I I -; i - I
1 �- ii ��t
Boathouse/' i b X 1; 1 1 L . - i-� -+- j i f-.!_ L .' - i s
t I I i -i �
Beach Bulldozing _,. 1__I t ' I. I -
�1 - � j j.
Other LiDi A V ie. - -t- -_._.-,--_�._ r;- ,- '-r-I- _ - - _. 1,-._,_
--I--1-- E tk$--... .. ..
: pt. i ''' ! - [-kJ
SieLength �Z� i _.L . _ ._.. _ l ! t1___ s(/__.- f 1 0. 11141 YL____ } .__-_- .j _ .._.
--f---t 1+ Y�
SAv: of s yes ® A -t- t 1 " - } es � : 1f/f..
Moratorium: n/a yes ® ,...- l j- lv `{
P
Photos. yes I t i j I r{'/ n� 1n. 01`/1 i • - -
i
_ t - r _ � r110"
Waiver A , I . i
:-
Waiver yes � _.:_._L�_____n � _ � J : I 1� �- I • j L. l I
'
A building permit may be required by: beAtA4C T Cry See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) 11��
Notes/Special Conditions t o+ I.. Mai Pr')IIhQU 14141n -}Yes, ?12r o tier W c�Iyy gn)I +o be
eke_vet'rce *o a nn2 il^'1t.trn DP 31" 0,r 3#. Artbeah r' 4- u3ih, 3Z02a o
(r' A l:DW IL ��o . Pic, 4. 'j ' m Of PXC. Crbf 'f-0M ee o4 mvs11. Qw•44e w%,a 9
r
iS / a-- "th k if i-‘44,)7
p ica t Printed Name Per f s Printed Name
;
Signature/► Please read compliance statement on back of permit** Signatureig` )
f igp0 iiJI di2C0• 1�1 /pp0 24o - Oc-f' - ZoZO 2/2- Fe - Zl
Application Fee(s) Check# Issuing Date Expiration Date

0 "LAMA / DREDGE & FILL N° 77431 A 0 C D
9ENERAL PERMIT Previous permit# 1.1 0
>�
New Modification ❑Complete Reissue Partial Reissue Date previous permit issued 01 41
As authorized by the State of North Carolina, Department of Environmental Quality HIi J
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC T • J 2c11
liv ules attached.
i Applicant Name E l i Zah eA-V\ Fe. -•\rl oV c u..) Project Location: County ,eavt,Dr k
Address y I �1eo15tare- 70.1 ^DEC`. Street Address/State Road/Lot#(s)
City ?At\i'N State OC., ZIP D480/5 S Li I T,rea$c.rre ?Dig-k- 't' '.
Phone # (Z5Z)993-5'53+9 E-Mail be.le1M. pev.• ►llo.gnc46i,,c.csa.Subdivision `rrcck�,r� Tc,i,,,A--
Authorized Agent T$•s 'IV\arliv...e. C,py16 City ')c( -`v\ - ZIP off-}$crag
Affected Day ❑EW SEPTA ❑ES ❑PTS Phone# (z52-)9 Lit/-lo591_ River
Basin T4R/ f??rri
❑OEA ❑HHF ❑IH ❑UBA ❑WA
AEC(s): Adj.Wtr. Body
' h , /man /unkn)
❑PWS. Heat-vex]/ e,'fie
ORW: yes / no PNA 0 / no =`^�'^. Closest Maj.Wtr. Body 1 Qw1 li Lb giver
Type of Project/Activity ? se Colrl5AY1-1 c4 c n Oc t'x'O' ?ier W% IL'XZo p/srbe'wr»
)a,<No coUcrJ a 132(13 beoe-W" am t] ivxyO'pler dl& SCk atm. ccci4tt MwsLL(Scale: In -- go
Pier(dock)length pD X to
Fixed Platforms
Floating Platform(s) I
��
�_. 1r
Finger pier(s) I r T r_..._} j j , S
_� 1....... f Gig•X 1
Groin length _ \ . j 1 • �c,v t'�f 4\ e t,� i
number — . .,up'
3tai 1I A— ( elp 1 t�
Bulkhead/Riprap length f. 1$AA!' I ' 1O0.1' t �0
avg distance offshore ( I
max distance offshore
I i 1
Basin,channel I
cubic yards — 1 1
— l
Boat ramp J
Boathouse/' 13X1,7 - 1 4 i ' i , ,
- - __ 1
� _ - i
Beach Bulldozing I - ___
Other 1 '
'7T7 !
out/ Goas tat \ieC
(
Mardi ' 4NOffflan
f
Shoreline Length - TZ 05
SAV: not sur- yes ® _ .. „(� �1 �_ I YY✓1
_
Moratorium: n/a yes no -
- Qe^ (pXp� c°a5 L i i !
Photos: yes 1
�1.1.. .
ors ; i,r ......... __I
Waiver Attached: yes el — (1 °
A building permit may be required by: �QAlACoC)- Cocay V See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) L /
Notes/Special Conditions C.o' IS f ailt74Alhtot w)4-h -frees, Fier p ver WLTAcjn S -1-o be
e -co4.\-c +c a miNlrnt,tm o 3[0" or 3 #. AnI/Ca04- ., 1.,,,,-,,, 32o z o
414,cir a1lo1,044l1 5 . --Z. ';e2r 1--arm not ir, ?X e) 9t' -Icror, e�ge o, ii1ly-511, Qom., watt-=9 -
"h '/ 7724)7
Agent or Applicant Printed Name Pe ,c s Printed Name
--
Signature **Please read compliance statement on back of permit** Signature or
re Chk li�.� _ . 131.90 z4,„ - ocri- - zoz.o 24- Fed- zl
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:
1_1/Tar-Pamlico River Basin Buffer Rules _ Other:
H 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 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

41❑CAMA/ ❑DREDGE & FILL N9 77431 A C) C D
GENERAL PERMIT Previous permit# :Jj
>`-= E New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued K1 1 i-
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 ? t' - 12 C .
lvfltules attached.
Applicant Name /` 1 i Z h r 4\ P.- Y��c\\c u.) Project Location: County t- ,1-, " Y
Address 4 \ T!E'H5 u,x"e Pc 1 r4 ' 'c. Street Address/State Road/Lot#(s)
City t) A State I`•�, ZIP D R-SS ug y I rr‘,.5t,.A f r 1 t— Dc
Phone#(Z'Z.)9y 3- 51539_E-Mail h-t k. 7-,•1,,.11: ,.f,..-, -i . Subdivision "T-,:,-,_.c,,.,- r Tc-;1�ic
Authorized Agent T 5 s s \car ,s.e i_L- Ins -. City f--,c:.�\,-1 ZIP I)—4 cc q. S
Affected ❑CV/ ❑EW EFTA ❑ES ❑PTS Phone# (-52 )9Li`I-(c,.4-1 River Basin TAR/PP r-r)
❑OEA D HHF ❑IH ❑UBA ❑N/A �� K
AEC(s): Adj.Wtr. Body j-k.r-vev r ; nat,/man /unkn)
❑ PWS:
ORW: yes / no PNA C�' / no T`�\ � Closest Maj.Wtr. Body 1(�n \'C o 1`�e�
Type of Project/Activity ?ro\Z st-i., C c (1 S}.do,(:{-,t;n 0-C ‘>"1x0 r,e, w'4, ,/h ',I20 9/a4 Corry)
,Cox lip cove fe0 a iJ$ 13 12,,h4�A- .$.4V CA90' re ..li ,ram; S.C. c..0' Cuu51-.1 ,,.,\4ra P r
Pier(dock)length 8 D x
Fixed Platform(s) j�.'J< Z(•• r'�� (..�]�aye,/ C IZEk K�-'�
ti,c)
Floating Platform(s) ; 4 Nt,
Finger pier(s) t
Groin length \ I C t7 'j. wi �7 tr ;
T
number 1 rca�Srt� �� !C �f
1. A i 3 -i-# 1.%
Bulkhead/Riprap length i - i LL
avg distance offshore
max distance offshore I I 1 Basin,channel . . i
cubic yards 1- ' ? }
Boat ramp i i
1
1
Boathouse/'Boatli$ 13 - -_..._.._........._...._.._............ _ _...................................... - ..._....._...... -.............._.._.. ._._._._._ ._.I.-.
Beach Bulldozing 1-- I ,~
Othert t p/A C Icy/ i{ j
! ! 1+ / i , ! bfi1a n
Shoreline Length � 3 Zt � ` i- 'I.
}- 5 r, t1 FRDi' I
SAV: of sure yes _ ` ! I T / rrt4-C \ I
Moratorium: n/a yes • I vn \` I �4-tad_..to.: /t i I -.._
Photos: yes I I- r Art' ..• a3 i 4V...t ' '
Waiver Attached: yes el I l I'
A building permit may be required by: bt?AU.Ct)!')- C(JUyt'['/ . I v See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) r
Notes/Special Conditions 4 ,4 rv't,2..4 1P-d W 141,, -f>!.*ds. 1 ' r ,/,,,<1"kc 1U s i he
?(. ' ,s ‘A,,,i3/ yy3�20L4'4 2^ c F u/kt+
447G.r 7; 7A7
Agent or Applicant Printed Name PermitOfficer's Printed Name -I
Signature **Please read compliance statement on back of permit** Signature
P(i i_'hK 5Z00.cS /7)140 2..& - oc-1- - 20z.0 210- r-,4 - Zozi
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
landowners .
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
u es 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(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

„, ;; ,
0'CAMA / DREDGE & FILL N° 77431 A BCD
GENERAL PERMIT _.. Previous permit#
> ❑New 11Modification DComplete Reissue ❑Partial Reissue Date previous permit issued
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 SA NCAC
❑Rules attached.
Applicant Name - -\ ` • \\,,-. . I Project Location: County
Address e ' --4, `-''c • Street Address/State Road/Lot#(s)
City State -";(_ ZIP -)4 C.
Phone#( ) E-Mail Subdivision
Authorized Agent City _ ZIP
Affected ❑CW ElEW ❑PTA ❑ES ❑PTS Phone# ( ) ;'i Y-( River Basin •
AEC(s): ❑OEA El HHF ❑IH ElUBA ❑N/A Adj.Wtr. Body • '- (pat /man /unkn)
❑ PWS: _
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity
, i '
(Se: i y'(j: )
Pier(dock)length r. I
Fixed Platform(s) {it. � I �- Q V �' ' C.j'{; r
i
i ,
Floating Platform(s)
i i ,
Finger pier(s) i k k^ `.. ........ I
F —
11
:Groin length P ! ' 1 r 1....
number �__.-_....._.�— i ;. <' �, ' �. i62 , ,' i — --
Bulkhead/Riprap length I V! . t t -...
avg distance offshore j [ I
” 1 i 4 i I
max distance offshore r i 1 f
Basin,channel i _- _ i •
,,,. '� /, C , �s, S
cubic yards i
Boat ramp i I � I j
l
Boathouse/Boatlift ' "X 1 , ._.. t----i-._.r ...._ t—MI _-- — —
Beach Bulldozing A, 1 -- } 1
Other i ' (j j�1 f.. r
4 I .( - 'Nit' rip,,,L'
Shoreline Length 4 C- {�
SAV: not sure yes I • ,.. ,_ — ,t-'' i t PEA. I
Moratorium: n/a yes n 4 7-1r -i
Photos: yes no, I _—... ! �r t i `.__.._...
Waiver Attached: yes no % '
A building permit may be required by: j'eicA 4Gr T t t..)a'►'t'/ . FlSee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions - ' 4 <
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
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 Ruls-Applicable To Your Project:
1/,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(910-796-72 15)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

Authorized Agent Consent Agreement
f/24e h//aJ
I' i ,herby authorize Tobin Jay Tetterton of
(Properly Owner(s )
TJ's Marine Construction,LLC to act on my behalf in obtaining CAMA permits for
the location liste
d below.
PROPERTY TJracuceADDDRESS:
"If/ ,—t- 0i,,
(66`,43
PROPERTY OWNER'S MAILING ADDRESS:
Phone No.a5--, -, c/ 4/ 66-g
i
PROPERTY OWNER'S SIGNATURE:
AUTHORIZED AGENT SIGNATURE; G `
TOBIN TETTE ON
DATE: 06 —'72? 20 yp
0 ()-©
W/AU horized Agent Consent Agree. ( / 3

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -- r")"}>( '") (4 j}1H°t-Lat)3
's
property located at 1?11 1 I l`� /-)5(ii - i�o 10`f" (j a of property Owner)
(Address, Lot, Block Road,etc.L.
on 'hh�
I3J � l? 1;11 in � 1 '
(Waterbody) , �,jc.. ) 1>Z�) D�:ST , N.C.
(City/Town and/or County)
- - The applicant has described to me, as shown below, the development proposed at the above
location 7);)
Adjacent ( J I have no objection to this proposal.
Property
Owner I have objections to this proposal.
Check one P P
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
at,►0 pin', /50 rr,- iojTN Ib'XXi7' p1ii--froom w/lam- ,-i[T
-----------„\
i 0 el- W-1511
, i .
s�r
ndJacent WAIVER SECTION
Pro erty
wI understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
ner must be set back a minimum distance of 15' from my area of riparian access unless waived by
mast me. (If you wish to waive the setback, you must igittaj the appropriate blank below.)
f Alai
One
I do wish to waive the 15'setback requirement.
I
ik
I do not wish to waive the 15' setback requirement.
(Property Owner Information) ( cent Property Owner Information)
Signature
tl_rz rk="7� �� -i�ii iL(.c�„> ate,l Le k S'2l rFfc�vzt PI: !y'� 1
Print or Type Name I n
113 N n'I t`);i�1 `31. Print or Type Name ti
Malting Address iressC' a� ft t(�tf T` 6
p�`A essA)C U�>3U Mailing AddressCftyiStateiziL`- '"; e�v°� /J c �3 t 3
aSt - 9 Y3-ys 3 9 tkyh 1'R1o//Pbq- —1 /i15'(»tl dy/State rp
Telephone Number/ mail address Ala �r-i-zumber! PL y.2-r- -rt e)VeviTelephone Number/e ail address
DateDate*`Valid for one calendar year after signature` (Revised Aug_ 2094)

f
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i-i c>9 ECM PC/N°1-c-d 1,3
s
ro (Name of Property Owner)
property located at e y j}�6HS 111 polo o r p .
on 1 -it+ GR��I� (Address, Lot, Block, Roads etc.)._
in � � �1�- �31t�� AT
(Waterbody) , N.C.
(City/Town and/or County) i
- The applicant has described to me, as shown below, the development proposed at the above
location./
Adjacent 1) `+n l I have no objection to this proposal.
Property
Owner
Check one I have objections to this proposal.
t
a DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
f)uill) Pi'EA /50 I T ta71-1 /6'Xo2a' pit- on W/5oAT g Fr 1
o
00 �iS1 r- I
ki,'— y, I
i
- i.
It-- .-t WAIV R SECTION
Property I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
OMust wner must be set back a minimum distance of 15'from my area of riparian access unless waived by
you y
me.
M (If wish to waive the setback, ou musntal the a
t Initial appropriate blank below.)
PP p
One g
I do wish to waive the 15'setback requirement.
i`
J) I do not wish to waive the 15'setback requirement. 1
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(Revised Aug. 2014)*Valid for one calendar year after signature*

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY Daeckn
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 & .0259. The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party (contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to $25,000 per day per violation.
>. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width:The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
• Pre-project site conditions: 1D�" �S 4 �(� � I►/► )4k
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By your signature below you agree to be held responsible for meeting all of the conditions listed ove and verify
that all information provided is complete and accurate.
Agent or Applicant Printed Name ermit 0 cer's Signa re
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Agent or Applicant Signature Issue Date
CAMA GENERAL PERMIT#: -1:341-)
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington.NC 27889 1252-946-6481
Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-3845 1910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 1 252-808-2808