Gombar, Bruce 79525C

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etv EModilication EComplete Reissue EPartid Reissue
by the Sate of North Carolina Depanment of ErMronmental Quallty
N9 79525 AE o D
Prcvious permit #
Dde prryious pemit is$red
As
and the C@s1al Resou
Applicam
Address
Name
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tn coarc€m pursuam to l5A NCAC
Proiect Locdion: County
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Authorized Agem
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TyF of ProiecU A.tivity t^
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FloatirE Pl*form(s)
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length
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Waiv€r AtEch€d:
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Statement of ComPliance and Consistency
This permit is sublect to compliance with this application, site drawing and attached general and sPecific conditions' Any
violiion of these ierms may subiect the permittee to a fine or criminal or cMl action; and may cause the Permit to become
nullandvoid.
This permit must be on the proiect site and accessible to the permit ofiicer when the Proiect is inspected for compliance' The
applicant cenilies by signingthis permit that I ) prior to undertaking any activities authorized by this permit, the apPlicant will
confer with appropriate local authorities to confirm that this proiect is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail reflrm receiPt has been obtained from the adiacent riParian
landowner(s) .
The State of Nonh Carolina and the Division of Coastal Management, in issuing this Permit under the best available
information and belief, certiry that this proiect is consistent with the North Carolina Coastal Managemelrt Program.
Rivcr Basin Rules ApPlkable To Your Proiect:
Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
lf indicated on front of permit, your proiect is subiect 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 ar.e enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Ofice (252-946-&481) or the
Wilmington RegionalOffice (910-796-7215) for more information on how to comPlywith these buffer rules.
Division of Coastal Management Clffices
Irlorehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-80&2808/ r -888-4RCOAST
Fayt:.252-247-1330
(Serves: Carteret, Craven, Onslow -
North of New Ri\€r lnlet- and Pamlico
Counties)
Elizabeth Cirv District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-2A4-3901
Farrr:.252-204-3721
(Serves: Camden, Chowan, Currih,ck,
Dare, Gdes, Pasquotank and Perquinuns
Comdes)
E oth".,
Washington District
943 Washington Square Mall
Washington, NC 27889
252-94('6481
Fax:.[phone]
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington Distrid
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9l0-796-7215
Fax [phone]
(Serves: Brunswick New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
httpt//portal.ncdenr.o€/web/cm/dcm-home
Revised 7106l I 7
CER TIFIED MAIL. RETU RN RECEIPT ESTED
Name of Property Owner:
Address of Property
(Lot or Streel #, Street Road, City & County)
Applicant phone x hto\ aex-475 t MailingAddress, eS*qa>
I hereby certify that I own property adjacent to the above referenccd property. The individual
applying for this permit has described to me as shown on the aftached drawing-the development
they are proposing. A descriotion or dralvinq. with dimensions. must be provided with this letter.
y' thave no objections to this proposal.
-
I have objections to this proposal.
lf you have obj*tions to whet is being proposd, you must notily the Dtvision of C@s',,l ,lenagcment
(DCtl) in wdtng wtthin 10 days of ,t,c€ipt of thls notlc.. Con,,,cl lfifomadon f?/r DCli orfices is
ay]alla e at wws.nccoasanmangementneuconbct-dcm.han or by calling ,aB8-IRCOAST. No
response is considered dle same as no obi*tion it you have be€.n notified bv Certified llail.
WATVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distiance of '15'from my area of riparian access unless waived by me. (lf you wish to
watve ck, you @Lid!ig! the appropriate blank below.)S
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner (Riparian Property Owner lnformation)
ature Signature
Jos^ l,htJ*',
Print or TyW Name
7 E*Jr fr
Mailing Address
'),rhe.u;//c P- AUTL
Citylstate/Zip
?to- Srlt-- Ortt
Telephone Number
x
Pint or TyW Name
Mailing Address
Citylstatemp
Telephone Number
Dale
-n-aI
Date
DIVISION OF COASTAL MANAGEIENT
ATUACENT RIPARIAN PROPERW OWNER NOTTFrcANON/WAIVER FORII
CERTIFIED RETURN RECEIPT ESTED
DIVISION OF COASTAL MANAGETIENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Nameof Property Owner: Brur-^e- /dar,lziz Gm ba.
Address of Property:
(Lot or Street #, Street Road, City & County)
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 developmenl
they are proposing. A descriotion or drawino. with dimensions. must be orovided with this letter.
I have no objections to this proposal. _ I have objections to this proposal.
tf you have obJections to what is being proposed, you must now the Division of Coasf,,l lrenagement
(DCtl) in witing wlthin 10 days of ,l'c€,lpt of this notlcc. Contacl infonnatlon tor DCil offices ,s
available at yruw.nccoastalmangemenlnet/contact-dcm.hhn or by celling 1'8881RCOAST. No
rcsponse ,3 corrs idered the same as no objection ff you have b*n notified by Cefiified ttail.
waive th e setback, you @L!!j!!g! the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.f
(Property Owner ldomation)
Signarure
l:a)ola,
(Riparian Property Owner lnformation)
Pint or TyW Name
City/Statezip
Telephone Number
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Print or Type Name
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Mailing Address
City/StateZip
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Telephone Number
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boafiouse, or lift must be set back a
minimum distance of 15'from my ar€a of riparian access unless waived by me. (lf you wish to
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Received From:C1l-.'brr^, c A.
NC Division of Coastal Management
Cashier's Official Receipt 1,441,9 A Bd>D
Date:,oQL
b 40
cnecxNo., **(o
(novtber
Permit No.:7Q 52qc
Applicant's Name:5d,t 0-County:6n<
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Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
-
Date:
Signature ot Field Representative:Date:
Project Address:
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