Schmucker, Jeff 80449C

-. CAMA / DREDGE & FILL
9 804- 9 A
B
C D
ENE L PERMIT
Previous permit#
ew ❑Modification [-]Complete Reissue
❑Partial Reissue
I
Date previo s permit issued
As authori ed by the State of North Carolina, Department of Environmental
Quality
�7
and the Coastal Resources ssion in an area of environmental concern pursuant to 15A NCAC
"?
R s attache
.
Applicant Name
Project Location:
County
Address
t
treet Addres
ate Road/ L 4s
City
State
ZIP
V V)
/
Phone # -Mail
Subdivi 'o
Authorized Agent
City6�{'
f j✓f
ZIP , ,
Lg l
Affected ElCW *W TA El ES
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA
❑ PWS:
ORW: yes / no PNA yes /
Type of Project/ Activity
❑ PTS Phone # '"w f2
❑ N/A Adj. Wtr. Body_( '1
Closest Maj. Wtr. Body
(Scale: /' `I ) )
Pier (dock) length` — — — — — —�
Fixed Platform(s) ®�
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length ---
i_
avg distance offshore i1 _
max distance offshore
Basin, cl-annel j A
cubic yard
Boat ramp
Boathouse/ Boatlift
Beach Bulldozi
Other
Shore ine Length XL�
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions Y-,00 (.rlA
Printed
Mature e e read compliance statement on back of permit
pplication Fee(s) e

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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J 6-
(Name of Property Owner)
property
located at � �
� � i (Address, Lot, Block, Road, etc.)
on A04� QAKO& in ,t-!QU.>ate N.C.
(Waterbody) (ityiTown 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 av_e obj��ti_ons to this_pr_opos:aL_.__
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
-T4W
P A oversly
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.
I do not wish to waive the. ,15' setback requirement.
Owner I
Si�rf'cature - 5 6 -X
Prm or Type Name
866
Mailing Address
Cik/StatelZ
Telephone Number
Date
(Adjacent Property Owner Information)
Sagna ure
Print or Type Name
S00 a'r
Mailing
dress
City/S telZilf
Telephone Number
Date
(Revised 611812012)

s

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J�'°°� �°°'' Is
(Name of Property Owner)
propeq located ata-
,Ive) 6,\a I vva (Address, Lot, Block, Road, etc.)
on tl �'t� in` N.C.
(Waterbody) ( ity/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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
t
A d Qrt m
--
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.
I do not wish to waive theA 5' setback requirement.
(Prpperty Owner Inforrna
Pnn or Type Name
Mailing Address �
Cif/Stafe/Zi 1
0 7
Telephone Number
Date
( 'acent Property Owner 1 formation)
POP( �Wo�er S
s at �;/�.,,� �� l� , �(s VPbA
6 Y6 s
Teleph�ne Number
`7 / 5-— zo o�
Date
�, F5S--7
(Revised 611812012)

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