Modular Technologies Inc 80445C

AMA / DREDGE &FILL i01 " ` '
NE L PERMIT Previous permit #
INew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Ctlrolina, Department of Environmental Quality
and the Coastal Res urces Commission n a area of nviro ental concern pursuant to 15A NCAC
les attached
Applicant Name ,,AA oject Location: County
Address 4v� 2bdi
eet Address/ State Road/ Lotf)e/#(s)
City /n� ate ZI %% f
Phone # `�l d Mail a `vxsipn
Authorized Agent
Affected ❑ cDPT
ww ❑jP�TA
AEC(s): ❑ OEA ElHHF ❑ H
PWS:
ORW: tes// no PNA yes /
Type of Project/ Activity
Pier (dock) length �--
Fixed Platform(s)
Floating Platform(,s -
Finger pier(s)
Groin length
number �_
Bulkhead/ Riprap length
avg distance offshore
max distance o fshore
Basin, c annel
cubic yards
Boat ramp
Boathouse/ BoatliF.
Beach
Other
Shoreline Length _/ I_
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
❑ ES ❑ PTS
❑ UBA ❑ N/A
Zor7�pplitaat'PFinted Name — —
Sig ature Please read compliance statement on backof permit"
9 � A'
plic io Fee( Check#
City
Phone #
Adj. Wtr.
Closest Maj. Wtr. Body
❑ Sqq note on back
Permit
Basin rules.
Si natpre ( -#�—
1'o /
xa'-
tsl4g Date tExpir4n 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 [)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 ❑ 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 (910-796-7215) 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 61 � � 1 � ��L C �? �
Mailing Address: _� 61-1�Zq971JkAl ' 0&- I L�t--
Phone Number:
Email Address:
I certify that I have authorized
NJCJYI c�►Q� /dPn/UCt`��il't ��/l
/'contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: ,L C % A-e
�. A I A
at my property located at
2
County.
l furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
Z -(-- I � 1- � -
Date
This certification is valid through l 1,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of party Ow
property located at � a� ' C
(Address, Lot, Block Road, etc.
on, t' !�� /�!r,✓L in
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca 'on.
1 have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individuai proposing development mast fill in description below or attach a site drawing)
Zo-c i2 _ �oX)ok Z, lS�af
~- tinII
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. (I ou wish to waive 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 Owner, f ation) (Adjacent Property Owner I formation)
,<
S17r,!na i�✓%�j/i�.G/'//�✓/ �YZ7" nuts n, .}fly //�AA/ �1t� Ji%F' s
Pint dr Type Name - "` Print or Type Name
etlln dre ,v Malling Address f
C -2AV o .7) e Cry ^ � ►1 ci il/ e
city tatetZlp City/ tate/Zip
Telephone umb r1 email address Telephone Numb email address
V /a/o7 0AA
Date Date*
(Revised Aug. 20141)
�\I—Ito 6.............I.....In..,......,to-...,.i...,.,a....,*

ADJACENT RIPARIAN PROPERTY/OWNER STATEMENT
I hereby certify that I own property adjacent to Z -i' z /� C'4 � � f ,s
(Name of Property Owner)
property located at hlll5/ 0/1 .
('I'� ^-f1rf (Address, Lot, Block Rod e
on _ bt L'fl. C O-e/ ..�_
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
f-.� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ond/vidual proposing development must fill In description below or *Hach a she 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. (if you wish to waive the setback, you must Initial the appropriate blank below.)
r' I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjac /nt Property Owwge%r Information)
7
aiure �-
Alt
or lime Name
Ma/ling Addresi 4
CitylStaftTp
Telephone Number/email address
Date*
(Revised Aug. 201 4)

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