King, Michael 80448C

-�T 1
Oautho
MA / DREDGE & FILL ��t�1 ` A B C D
NE L PERMIT Previous permit #
w ❑Modification ❑Complete Reissue El Partial Reissue Date previous rmit issued
by theState of North Carolina, Department of Environmental Quality f
and the Coastal Reso rces Com fission in a rea of environmental concern pursuant to 15A NCAC
. ElfwWattac
Applicant Name Project Location: County
Addrr s Street Address/ State4Road/nLt #(s)
IN 1il',�1,
NI
/��
+
■ 11 ■ ■ '
�/_
• - Ii^ram_
pul.,
I Iml 0 ,
.
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing'
Other
U f1 t
Shoreline Length
SAV: not sure yes I no
Moratorium: n/a yes Ln
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Sp�ial goriditlons
Agent or Apt rcant Printed Name
Signs lure as read compliance statement on back of ermit **
Application Fee(s) Check#
❑ See note on back regarding River Basin
Permit Officer's
Signature
(01
Issuin D to Expir tion 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, 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 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/ I-888-4RCOAST 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: k-'Il\j L,
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
E
4- yZ -`?//')) -A63ST
JC1Y10 ak, o aSS a I - �dcl' lui
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
�
necessary for the following proposed development:��a„��
bald 14 f ell 4e
at my property located at 74FR � Af
9-�
in 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 infonnation related to this
,permit application.
Property Owner Information:
Signature
Print or Type Name
Title
1 -'• / l
Date
This certification is valid through ' /

a

AT RI_PARIAtd PROPERTY OWNER STATEMENT
Y 's
I hereby certify that I own property adjacent to i �Y-6 �N e �f P c
Owner) -
property located at
on 91VLL Crr D� l��Ef;_
(waterbody)
is, Lot, Block, Road, etc.) , N C
In K r
{CltyiTown 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 rOF�P���OSr EW DEVELOPMENT
a site drawing)
(individual proposing development m
`I
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 iV setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information) (Adjacent Property Owner Information)
Signature /V16 fA't-' L. l�/lam G� Signature* Z
Print or T Name
Type
s ME%'1 ��✓� a�
MailingAclll�C
Gity/slatelziply' t-(
Telephone Number/ email address
Date
Print or Type Name
Malling. Address
Telephone Number/ email address
Date* '
(.Rovised Aug. 2014;

ADJACENT RIPARIAN PRQPERTY OWNER STATEM9
I hereby certify that I own property adjacent to rc z � � f r �� (��y 's
(Name of Property Owner)
property located at � f � N�� ('T�' -v c. A�
(Address, Lot, Block, Road, etc.)
on Lf)AIi- Grl= PkO; Rctk f lxra'cct'., , in 61-ow LL'1 L� , N.C.
(Warterbody) (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
11ndividua/ proposing development must flit in description below or attach a site drawing)
W
F 7` %fin'
"` itsry�b floct<, NOT
�4N47 or
Te tExcttb 30 C U tiGCS .
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 Owner Information)
Signature
Print or T pe Name
Mailing Addre s
CAM_ CA-0-7-4-9t� �
City/statw0p4le A �'q
Telephone Number/email add ss
Ei2 SS 4j1-,v ' l 7 (� `w N►ut � Cam+
Date
(Adjacent Property information)
Print or Type Name
Mail! g-Address
City/S# p
Telephone Number / email address
Date*
(Revised Aug. 2094;

A
u m
F N E
U !. E �
O � 2
m�
t �
4-1 1 0
4 1!e o oo
D
�o
Sy r o
i o
k � t
va
E
r
!r E�
I ri s z<n II o m v
°
* , y., 3 -
7,..ia U E
NN°
«� i6
�Uc
N
00
� M �fN
.�i
N p as
M $
11 m>
W W LO 10 y 8
rx w b p N
E.
o w w W b b g v o
3 M
a 0000
v �v
� LO 00 w �o �4 x a
LO coH O% '+ N M
��• d' W U W O U 3 M W ,�7! m V OLO
3 c
40
Cl) oo
LO
C4 cq co co
OD
v ..
b a w po �' 04 � c �"
q c�. Z
N �i+ � E d
1O .a a a U o4 tl, H H A a pa F� va A w A o� < Q.

�swi
� F!1
W
1.
� 1
i t S
r
f'
C
f
f
'
i