Brown, Jeb 79553C

Applicant Name _
Address
/trDREDGE&FILL
NER/AL PERMIT
IModification [lCompleteReissue EPartialReissue
fu authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pu rsuant to l54 NCAC
N979553 A B,,'c.oPreviouspermit# " --
Date previous permit issued_
E Rules attached.
Street Address/ State Road/ Lot #(s)_
Subdivision
ZIP
Phone # (_)River Basin
Adi. Wtr. Body__ (nat /man /unkn)
Closest Mal. Wtr. Body
State ZIP
Phone # (_)
Authorized Agent
E-Mail
Affected
AEC(s):
ncw
trOEA
! PWS:
flEw
N HHF
tr PTA
trtH
trES
tr UBA
trPTS
trN/A
ORW: yes / no PNA yes / no
,
Type of ProjecU Activity t
(Scale:)
Pier (dock) len4h
Fixed Platform(s)T
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Floating Platform(s)
r
[:1*"i*+*-
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l.!,*
Finger pier(s) I ,f___..11_11_!_*,-t*+t--
Groin length
number -JJ:Bulkhead/ Riprap length
ave distance offshord
,o diran." off h"jt-
-+-+--+rit
Basin, channel It
-I
1.
'-i-
1
cubic yards +
Boat ramp
tBoathouse/ Boatlift k
Beach Bulldozing
Other
\t
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--u--i--L+-f+
Shoreline Length
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes no
yes no
yes no
.,]
I
A building permit may be required by:
( Note Local Planning Jurisdiction)
fl S"" note on back regarding River Basin rules
t,
Notes/ Special Conditions
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Permit Officer's Printed Name
Signature
Application Fee(s)Check#lssuing Date Expiration Date
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River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
E oth.r,
lf indicated on front of permit, your project 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 are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Olfice (252-946-6481) or the
Wilmington Regional Office (9 I 0-796-7215)lor more information on how to comply with these buffer rules.
Morehead City Headquarters
400 Commerce Ave
Morehead Ciq/, NC 28557
252-808-2808/ I -888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Coumies)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-U8t
Fax:252-948-M78
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and WashinSton Counties)
Wilmington Oistrict
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-72t5
Fax: 9 I 0-395-3964
(Serves: Bruns,wick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://ponal.ncdenr.or&/web/cm/dcm-home
Revised 7/06/ I 7
Statement of Compliance and Consistency
This permit is subiect to compliance with this application, site drawint and attached general and specific conditions. Any
violation of these terms may subiect the permittee to afine or criminal or civilaction; and may cause the perrnit to become
nullandvoid.
This permit must be on the project site and accessibletothe permit officer when the proiect is inspected forcompliance. The
applicant certifies by sitning this permitthat l) priorto undertaking any activities authorized bythis 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 return receipt has been obtained from the adiacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best arrailable
information and belief, certif thatthis proiect is consistent with the North Carolina Coastal Management Progftrm.
DMsion of Coastal Management Of,ices
Elizabeth Citv District
401 S. Griffin St.
Ste. 300
Elizab€th City, NC 27909
252-264-390t
Fax:[phone]
(Serves: Ca.nden, Chowan, Cu.rituck
Dare, Gates, Pasquoank and Perquimans
Coumies)
ADJACENT RIPARIAN PROP ERTY OWNER STATEMENT
property located at ZY f)u,L^lL,, u$;l?/,"",,f"'tvoffi
on n)(Address, Lot,Elo
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{s.t v,fi', N.C.tn
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividual proposing development must fill in description below or atlach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by
me. (lf you wish to waive the setback, you mu,gt-lnitial the appropriate blank below.)
(Prope o r lnformation jac nt pe Owner lnformation)
,4*
Siptcture" .l€9 br,vi ature*EV/u*e ?,rzCstt-
Print or Tvoe NameJ{ B'uzroat tl*ce
Mailino Address'''"'(i'i,lil1i,itr, Jc 265'Jo Mailino Address..TAZL-SottPat-4- PL
"i[!|fiff" J,L ^/,,,n^ D gn,, l.t,n "''$'iK'\ &f 7zt 5
Teleph one N er email address'
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,**,/up,l:i,t3,t7
MAY 1 3 l02l
(Revised Auq.2014)
DCM.MHD CITY
Dote
*Valid for one calendar year after signalure'
Datea
I hereby certify that I own property adjacent to C Eq f, @VL ,J ',
f.,*,(Waterbody) (City/Town and/or County)
has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
The appligant,:Y
ljo wish to waive the 15' setback reouiremenl.
-/
I do not wish to waive the 1S' se\qacf requirement.
Print or Tvoe Name
2y r.L.L" (r
RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jgq Brzowrl
property located at 21 r)u, h^ f h,,[ : "',],?f ' " XJt* " 7-) * sti o
S
on 0l* \urr (Address, Lot, Blpc(, Road, etc.)
, in ,-hc[ rd.a./,{Y a.lc , N.C
The applicanttocp.-
(Waterbody)(City/Town and/or County)
has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividual proposing development must fill in description below or attach a site drawing)
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. (lf 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 lnformation)(Adjacent Pro perty Owner I rmation)
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Print or Tvoe Name . tLo'z ,/rrr. 5D
f/c L 1.lo Mailino Address
J a cL<ttt t t/, .t/. /U c ZtSqo
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/ emailaddress
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Print or
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\*,'/-^?'"f;t-*#L" r,r,,rru,.rt /..te6,'ro,'/.,*^t ccl Telephone Number / emait affie5:P-ZL ss RECE|VED
MAY I 3 ?ATt
(Revised Aug.2014)
DCM.MHD CITY
Date
*Valid for one calendar year after signature*
Date*
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REGEIVED U
MAY 1 $ 2021
DCM.MHD CITY
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NC Division of Coastal Management
Cashier,s Official Receipt 74779 A BG\D
-?1on
Oate:,l zdl-
Permit No.i 5 (
Applicant,s Name:
Beceived From:
Project Address:
tttOr|yl;b 6sCheck No.:
County:/ou
e1 Q
Please retain receipt for your records as proof of payment for permit issued
Signature of Agent or Applicanti
Signature of Field Representative:
Date
Date:
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