77735D - Pollert

41111) LAMA / DREDGE & FILL N° 77735
FNERAL PERMIT Previous permit # A B C
r1New - Modification ❑Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality l
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC "� •J O C]
❑Rules attached.
Applicant Name - NA u r ko I (.),--1- Project Location: County UV(I(,) v,/
Address 4 0 (1)U "I -t- 5 Street Address/State Road/Lot#(s)
City /t, F 1 L State -C ZIPZ "..4A'S -'
Phone # (j l O ) )61 0-ZjlZ2- E-Mail - Subdivision
Authorized Agent 7A ✓d Y4'k City 7.1 ZIP Z alks
Affected ❑CW E EW W-PTA 'ES rPTS Phone # ( ) River Basin 1."/ • a •
❑OEA ❑HHF ❑IH ❑UBA ❑N/A [� (nat /unkn)
AEC(s): Adj.Wtr. Body l 4 NA 0.4 .SG
❑PWS:
ORW: yes /( PNA yes Closest Maj. Wtr. Body </l"pt./0 Cam
Type of Project/Activity 1 -. ,//,t.Cli A/ /i d...:' -,i i r/d-ki
(Scale: f :l ,) )
Pier(dock)length . , _
Fixed Platform
(s) lS �X 2 3 Floating Platform(s) i I 7. flj -
jFinger pier(s) ;i/ G',1/1 6�,
Groin length - � ;
number t ..- I i i -.---
I i
Bulkhead/Riprap length ' /
avg distance offshore / / j
I
max distance offshore / _ i
_ 04 GL'V(.Aa��
Basin,channel 1 A {
cubic yards i
Boat ramp — 6H C �. t.l�.
"fa �� P R I ,
Boathouse/Boatlift \ �"—' 11p +'
I ' f
Beach Bulldozing _ 7 I �.'"K-'f � 4 . I
Other ri`. t . - ek.ft)! -4T1 •
i 1
Shoreline Length / SS { I + 1 i .
SAV: not sure yes r6e. I I
Moratorium: n/a yes ' I i 1
Photos: yesiii 1 ___ _
Waiver Attached: es no '
I , I
A building permit may be required by: f i i (--fT . , ,See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
/,„%yry',1_,,// r''.:::-1/,.. 1-;1; r,f,,., .44 p_____.--
Agent or Applicant Printed Nalrr Permit Officer's Printed Name
.' Signature "Please read compliance statement on back of permit** at e
///7-\. 3 -/4-. / / • / c. q ,, . /c---. 2 /
Application Fee(s) Check# Issuing Date Expiration Date

11,
•
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 (252-946-6481) 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 252-946-6481
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

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kbuildinK.permit *,may be ..1 ••4'./-: -, -. : ..
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(Note Local.Planninifuriscktion) " - -- - -- - ' : .' " '''' , '.,'": - : :
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ens Applicant Printed N:';/.- ' -iti:24"e
Signature .:-:1:901,71:.7!,..1.17!.d:N.aitteri
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.44Pleasreiic omp l';ce statementon backI4'Rerrnit
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xpoeotierioe0:0) Checkrte" . Issui0g: ate ?sp.alt! n Date
-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ')(-_'t,K%,A•(Z rPC LL F(L 1
(Name of Property Owner)
property located at 3( 5 "NAM ST.
(Address, Lot, Block, Road,netc-.) 5"2F
on `00.14L. , in Or.t ,Qk W• C , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
l7 I have no objection to this proposal.
i
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)
r15,) ^'1
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
fi V 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(PropeOwner Inform,'on) (Adjac r�t Property Owner Information)
• x A 1 a 4-AA
Signature Signatur
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2 'FIL�D.LL L.
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Print/o`T Type Name Print or Type Name
Mailing Address Mailing Ad r ss
sv c,-ry <v o‘-'14-C,›uLc.c.E
City/ tate/Zi City/State/Zip
i11— 9v ( t9 g3�Z
Telephone Number Telephone Number
i0-0).0—a0 - ----C.a.
Date Date
(Revised 6/18/2012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
's:t`/ I'hereby certify that I own property adjacent to JeL\ L. Fa'1-�Na- ) o li eirc 's
(Name of Property Owner)
' property located at . �®('© off?✓`� ���'ee,t -
(Address, Lot; Block, Row!, etc.)
on 3r4 Sfrt C r.u.) , in ST'f C- V , N.C.
(Waterbody) (City/Towh and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
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) .
PQ iaL4- '11 0 Lv*ACzdian-d re&16 1ih d
Core if) '/'' s'i&e-- . .
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WAIVER SECTION ;y_..
I understand that a pier, dock, mooring pilings, 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.) ,V I do wish to waive the 15' setback requirement. 1C- l v MCA. ora .
/
I do not wish to waive the 15' setback requirement.
(Prope4.-11-9---0 (2,.-4/117)
ner Information) (Adjacent Prope Owner Information)
Signature Si e a.G �� AA
Print or Type Name Print or Type N e 7
dS fo j�
0 4/ )- r (Ito 3 !f/yh.leie 44
Mailing Address Maili g Addre s
City/State/Zip / C' /St e/Zip
P/O- Wo- o31/� 2 1 3,E 1 8-SBaa-
Telephone Number Telephone Number-
/e,-/- 0 —2c.) /1//7ao.2o
Date Date
(Revised 6/18/2012)

Check
Date Received Date Dapoalted Check From(Neme) Name of Permit holder Vendor 11/ amount Permit NumbrtComments Receipt or Refund/Reallocated
Columnl Column2 Cokimn3 Columns Column& Column. CaMam7 Column", Cowmn9
1202021 Cobman Building Company.LLC Wade Coleman Frrsl Bank 1 3122 S 200.00'OP*777250 BB rct 13503
1202021 55 Construction LLC Byron Walsh BBBT 2535 $ 200.00 GP 4777470 BB rct 13648
1/20/2021, RG Marne Contracbn4/Ronnie George Robert Herr Jr Bank of America 1061 $ 200.00 GP 477714D BB rot 13647
1/20/2021 Paul R Wachsmuth same BOOT 1237 $ 200.30 GP k77724D BB rn 13650 _
1202021 Brandon Grimes Money Order Carpenter Rentals LLC Wells Fargo Bank 19-088347323 $ 400 00 GP 1077555D BB rot 13649 _
1202021 ,Brandon Grimes Money Order Town of 01B Wells Fargo Bank 19-088347324 $ 400.00 GP a77722D BB rct 13502
120202t Jill end James Kenler Stale Employees Cu 7788 5 200.00 GP a77712D BB rct 13643
1202021 Clements Marine Construction Odd Gunther FCB 5635 S 400 00 GP a77749D KE rot 13664
1/20/2021 Lighthouse Marine Construction Delmar Pollert Coastal Bank and Trust 3577 5 603 00 GP a77735D JD rot 13604
----_ _.
1202021 Vance Morgan 01 Money Order Jack Morgan BOKF.NA 20983001434 5 200 00 GP.77538D Tmac rot 13576 _
1202021 McPherson Manna Services.LLC James Banks FCB L 3867 $ 200 00 GP 177626D Tmac rct 13577 __
1202021 McPherson Marne Services.LLC Jacob Suloyski FCB 3868 $ 400.00•OP l77&27D Triter rct 13578
_ 1/20/2021 Moose Construction _ .Edward Da .BOOT 1771 $ 00 t3P.77732D JD rc1 11750 __
1/202021 Buda Sniff Money Order Douglas Gas, Wells Fargo Bank _ 5918722560.$ 200.00 OP E/77733D JD rct 13602 __
1/20/2021 Aaron Burleson Money Order same PNC Bank 779189 $ 200.00'OP E/77731D JD rct 13601
120/2021 Marilyn F Dar_.- Brun Day Citizens Bank and Trust 4424 S ?OD 00 GP 077746b 8B rct.13646 _ _
120/2021 Jerry Fnnett Jason Door Coastal Bank and Trost 3508 $ 200 00 GP 677734D JD rcS 13003