Collins, Thomas 80447C

.�. CAMA / REDGE & FILL 1 TO 80447
ENE L PERMIT Previous permit # A C
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As autho ized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resource ommission in an ar oenvironmgentarn pursuant to 15A NCAC
7�
es atta ed.
Applicant me Project Locatio7Coun��Addres Street Address/ /Lot #( )
Ci ate/1
Phone _ ;I — Subdivisigq_
Authorized Agent
Affected ❑ Cw
AEC s ❑ OEA
ORW: (des //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�_s
avg distance offshor4
--�aiax distance offshore
cubic yards
Boat ramp `____--- /
Boathouse/ Boatlift —"'
c
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes fo
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
city
El ES ❑PTS Phone #
❑ UBA ❑ N/A Adj. Wtr. Body
A building permit may be required by�
( Note Local Planning Jurisdiction) / Y I
Notes/ Slecial Condipjons �/
Closest Maj. Wtr. Body
Permit
(Scale:
❑ See�bi, to on back regarding River �asjn rules.
t�re\' e e read compliance statement on back of permit Si atu
pplication Fee(s) Check# Issuing Date Expiration 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 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, certifythat 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 (910-796-7215) for more information on how to complywith 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 - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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 AUTHORIZA,riON FOR -LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ^/�%- s c��IJ
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at IS
in County.
1 furthermore certify that I 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:
gnature
,/tom"'"i'.J ✓�%�
Print or Type Name
Title
f-21
Date
This certification is valid throughl/

I hereby certify that I own property adjacent to
property located aj`°�
(Address,
on
in
(Waterbody)
Is
Name gProperty Owner)
�s,goad, et.
V.C.
( ty/Town and/or County)
The a licant has described to me, as shown below, the development proposed at the above
iocat' n.
I have no objection to this proposal.
Ir
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}
LA AIVER 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.)
_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property er info tion) (Adjacent Property Owner Information)
Telephorjo Number/email address
Date -- _
RR",
WAWOW
Print or
_._,. lT-T(777 z L-1 01 W�
Telephone Number/email address
u 7 I. el 1
Date*
(Revised Aug. 2014)
'�\ /..li.4 f..« ..........1.....-1..� ......P ..C+r.v ni.vnv.c..s.�,+�'

r �
� 'Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tofi�f-�ls ����,�_ �s
property located at 4.. -� �i�,� f� Name o P,roperty Owner)
�2 l` (Address, Lots; Block, Ro,Bd, eta.
on�`'r' C /lam , in t'-�� C �' "7"��-%� , N.C.
(Waterbody) (City/Town 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 roust fill In description below or attach a elt+a drowiagjE
L',, - V
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(PropertyOpner 1 ormation) (Ad�ac nt PropQ/fty O nor Inform"tion)
z a_ 'r Signature*
/
Print '_ `
t Ty a Nam Print or Type Name
ds
Mailing, AWd ss
c /sta" ciryistare2ip
Telephone Number 19 l as dre s
Date
Telephone Number email address
Date'
(Revised Aug. 2014)

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