Downey, William 80417C

CAMA / ❑ REDGE & FILL � V O 80417 A B /(C ) D
ENE PERMIT Previouspermit # ��/
w [-]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern ursuant to 15A NCAC Aan(o 44)q,
l
Rules atta ed.
Applicant j�l ame ^ki� �44 / /� �� "Project Location: County
Add
Authorized Agenl -----J
Street Address/ State Road/ Lot #(s)
Subdivision A

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, certify that 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 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

Fd.$ 6 00
CA jq-- lg55
Locality
Occan Hazard Estuarine Shoreline ORW Shoreline
(For gJTwial Ilse o)rlt')
GENERAL INFORMATION
Permit Number
public Trust Shoreline Other
RECE li(".i�
LAND OWNER - MAI`ANG ADDRESS
Name Ll �r
MAY 14 2021
DCM-MHD CITY
Address
City ��-� � . state Z-,
AUTHORIZED AGENT
r
Name ---
Address
City
Email
State zip I bone ----
LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.)
sad n► c e�i � F Nc
/,lam
DESCRIPTION OF PROJECT: (List all proposed construction and land dislurbance.)
SIZE OF I,OT/PARCEL: square feet q� acres
PROPOSED USE: Residential ❑ (Single-family ❑ Multi -family ❑) Commercial/Industrial'N Other (]
COMPLETE, EITHER (1) OR (2) BELOW (Coiuuct yow• Local 1 erruit Officer if you are #rot sure which AEC applies
to your properttp):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: squarc feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL, SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES:� square feet (includes the area of the foundation of all buildings, driveways, covered decks,
�
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGI?yIENT PERMIT: Is the project located in an area subject to a Slate
Stormwatcr Management Permit issued by the NC Division of Energy, Mineral and Land Resources (DEMLR)?
YES N0-X—
If yes, list the total built upon area/imperviot►s surface allowed for your lot or parcel: square 1'ect.

OTHER PERMITS MAY BE REQUIRED: The activity you arc planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
1, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record title, Title is vested in name of �� Nj"517, MyE
see Deed Book % 7 z i page %b O in the County Registry of Deeds.
_an owner by virtue of inheritance. Applicant is an heir to the estate of
._—; probate was in
County.
i f other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OFADJACENT RIPARIAN PROPERTY OWNERS:
l furthermore certify that the following persons are owners of properties adjoining this property. I affirm that 1 have given
ACTUAL. NOTICE to each of them concerning my intent to develop this property and to apply fora CAMA permit.
(Name) (Address)
(4) Aif-fed) .P/J:f(2(.. r`A)d- J1W
�Ow fj�O 5" v C.
ACKNOWLEDGEMENTS:
1, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I 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.
This the _ day of , 20 � 1
Lan owner or person auth ed to act as I 's r agent for purpo�e of filing a CAMA permit application
This application inclrtrtes: general ht rm n Ohis. form), a site (bviving cis desc►•ibed on the back of this applicalion, the
oiynership slalenrent, the Oceem Hazard AEC Notice where necessar)), (r clieck for Sl00.00 mottle payable to the locality, and
tiny information as rnav be prnvicled orally 1)), the applicant. The details• q/'1he application as described by these sorrrres arcs
incorl,ioratecl without rCfer'ence in anj, pei-mil which rnav be issnecl. Devici on fivin these details hill consti/nle a violation of
arrn permit. Any person developing in an AEC without permit is subject to civil, criminal and adminislrolive gelion.
N���IVED
MAY 14 2021
DCM-MHD CITY

c

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to it U-, fiom A 32owp Sr s
(Na a of P operty Owne
Property located at b Av-�r L JE P ,�� 74KSg, U r
on A G('1 �r wNc) (Address, Lot, I �ck, oad, eta,, }
in _. (- a N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocatign.
�._ I have no objection to this proposal.
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)
Sec 04)74-c�e�
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 16 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). (Adjacent Property Owner Information)
gnat ure Signature
Print or Type Name Print or Type Name
4nJL& aC)
Mailing Address t_ Mailing Address
City/statea,- a�5 CiVState2ip
Telephone Number/email address Telephone Number/email address
Date
(Revised Aug. 2014), ,
'Valid for one calendar year after signature" 6 �!
MAY 14 2021
DCM-MHD CITY

ADJACEN! RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to # 0 ; /t4 th A Pow u �r. s
_ I (Na a of P operty wnerf
property located at _ btu 4't4 C � e r a- , x}vt�e�_
on _A u Gkh wl"- I (Address, Lot, lock, Road, et
in �+ L Nx -C N.C.
(Waterbody) (CitytTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_ _�i I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(tndividuat proposing development must NY 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. (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 16 setback requirement,
(Property Owner Information)
(Adjacent Property Owner Information)
Si ra tre T
,Signature*
-�v�-tl_' l�rr�lc.rX-rcl�
Print or T pe Name
�/.t-/n_?l3 Attnhirc�yA��1�.sus�wy
Print or Type Name
Mailing Addmss
AZIA#,t1l t3,_n4t rlC
Mailing Address
City/State/Zip
O' f-Z0L'S[.''qS
City/stamaip
Telephone Number/email address
Telephone Number/email address
Dare
Dace •
'Valid for one calendar year after signature'
(Revised Aug QF-IVED
MAY 14 2021
DCM-MHD CITY_.

MAY 14 2021
DCM-MHD

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