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AMA / ❑DREDGE &FILL N9 78231 A B D
ENRAL PERMIT Previous permit#
New Modific io_ ❑o�m(/plete Reissue [!]Partial Reissue Dat revious permit issued
As autho 'zed by the St of o a i a �"epartment of Environmental Quality
and the Coastal Resources Commission in an area of environmental oncern pursuant to 15A NCAC
ules a ched.
Applicant Name Q Q( Project Location: County
rn VA
Addre Street Addd/rr / State Road/ Lot (s) .
Ciry State ZIP
Phone # n _M it SubdivRinn / --A l
Authorized Agent
Affected ElCW
AEC(s): ❑OEA
YJEW PTA 'El ES ❑PTS
TTT❑l HHF H ❑UBA ❑N/A
CRW: es /) no PNA yes
Type of ProJject/ Activity -au
Pier (dock) lengt
Fixed Platform(s) IT
Floating Platform(s)
Finger pier(s)
Groin length v
number { \\
Bulkhead/Nprap length {—
``1�/%✓ _
avg distance offshore
max distance
Basin, channel`---
cubic yards
Boat ramp
Boathous [lift ,^
Beach Bulldozing
�r; 1 'I
Other NVAVIO, i,AA/
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: es o
—/
A building permit may be required
����
byl U 1.17 p( (/t
'
( Note Local Planning Jurisdictit
Notes/ Specjal Conditions
,
.Arent or Adblicant Printer Name
read compliance statement on
City
Phone # all
Adj. Wtr. Body
Closest Maj. Wtr. Body
jjYl �
See note on ba,
River
ZIP
(Scale:'' r f )
1
River Basin rules.
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 isinspected 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 ❑
❑ 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST�
Fax: 252-247-3330
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(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
.�fAF ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -Tohn 91 Tq rJ S F) "rAFIc�G s
(Name of Property Owner)
property located at /07 L'gpE POn✓7" iaGf/� -
on $G)►ool i ibuSe! Cf CeIC (Address, Lot, Block, Road, etc.)
in 44o_4" 64r71VRET N.C.
(Waterbody) (CIty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca '' n.
Y n�D 1 have no objection to this proposal.
_.M .__Jhave QbjectO,pa tolhis;proposal-_—
�,r
DESCRIPTION AND/OR DRAWING i
T 7 _
it it -
' l�i11I
Calf-�
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.)
I do wish to waive the 15' setback requirement.
✓ M D I do not wish to waive the 15' setback requirement.
(Property
w''����i��!
Print or Type Name
/A7^nnir Pn/w/'T S4VD
.:S /Z.I
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r
Owner
Signature
Mr-hap-1 ! i
Print or Type Name
_117- 8�6ui��}e f' cd
Mailing Address
Z85RN
Cdy/State2lp
�252� 2Kt 8197
Telephone Number
10'ta I ?oLo _
Dare — --
(Revised &1 a/2012)
tip
(Property Owner nn
ZL Q.
Print
1/0 -
Number
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I ownproperty
� adjacent to .JOhr% a'SgtJ .9qN-rARtt`Fr!, .s
Property located at I O7 CApG Powr gouD (Name of Property Owner)
on J^Chtwl l�yvsC �retk (Address, Lot, Block Road, etc.)
in _ Re Ur-mrc-r N.C.
Materbody) (City/Town and/or County)
The app' ant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
2bj%tions_to fhis.pcoposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below orattach a site drawing)
a ..
j l l it
/l!I
rSe`l wcl'
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 tow ive 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.
(Adjacent / Property Owner Information)
Signature an d%I�t�an�%
Print or Tie Nam�-
� ,ZOLO
)—Y ir
IN
(Revised N1 &2012)
I
I
"DF ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Tohn At TF114 SC-inl TgFL--.bt .a
�t
D d(Name of Property Owner)
property located at f�% eyll /D,,,%
on ,$C)'10o1 House Cr ee-4 (Address, Lot, Block, Road, etc.)
in 4VE eA.17 E'te*r
(Waterbody) F(City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
loca ' n.
ZD I have no objection to this proposal.
J
j1 )
r
}III
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.)
I do wish to waive the 15' setback requirement.
✓MD I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjac nt party Owner I (rmation)
i "gr tine 2• n ®Signs//lure .'
Print or Type Name Pnnt or Type Name
!r /"0/W'T /4LVA Ill
Mailingn�ress ? G CAS Nailing Address
�A,t•TL�it ' N`% CooE Cnc}___ ec�-N c__Z85�N
city/�tale/Zip (� Cily/3tate/Lp
376 - -5 C25n 2 f I 8197
Telephone Number Telephone Number
Dare - Date - _---
(Revised 6/182012)
"« .
E
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own Property adjacent toJO,�'1TgA1 .�grdARPR's
property located at 167 Cane POtAr'r gtvD (Name of Property Owner)
on SGhcwl ({��5� er a (Address, Lot, Block Road, etc.)
G r in _C11pe Gr-TV,rr--r N.C.
(Waterbody) (City/Town and/or County)
The app' ant has described to me, as shown below, the development proposed at the above
locatio
have no objection to this proposal.
-- —.--- --__lbave_objections-to-this.proposaL .. _ .-
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below orattach a site drawing)
�) Al
r Ca2f `•n
r
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouselift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish tow ive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow�?r In low (Adjacent Property Owner Information)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J6h r1 -!Qr)?J A•u2DK. 's
(Name of Property Owner)
Property located at I b"] Cn�� Pbrnrf• $t l
///I (Address, Lot, Block Road, etc.)
on SCV)wl 14wSG t_rGGK in Clipe QAr-� rCT N.C.
(Waterbody) I (City/Town and/or County)
The app ant has described to me, as shown below, the development proposed at the above
7locatio
I have no objection to this proposal.
---- 1ba\Ce 4bjections_to-this.proposaL .... ... .
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below orattach a site drawing)
l_. j
t j
----
' S ew L ' I'
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 w iv the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner
M
Rio - �3 /A - &4a
Number
- .20& .
(Adjacent Property Owner Information)
Print l Type Namg
e err ai
0 .%S 1-Y f,
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Tat Nt ber
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Date
(Revised &1 &2012)