Flowers, Barbara 80438C

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CAMA/ DREDGE & FILL 1�� 804 38 A B
ENE L PERMIT Previous permit #
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authori ed by the State of North Carolina, Department of Environmental Quality o
(j-
and the Coastal Res ces Com ission in an area of envi*onmentalconcern ursuant to 15A NCAC 16 r
les a d.
Applicant Name Project Location: County
Addres Street Address/ State R Lot #(s)
City State _
&C-S _
Authorized Agent
"KA A (
CW
Affected
�W I�PTA ES ElPTS
TUBA
❑ OEA
AEC(s):
❑ HHF ElIH ❑ N/A
❑ PW•
ORW: yes / �orFPNA
yes / (n�)

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 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

. `,� .a'�r Y.�-'., �� ��T ��"�� ate- _ - --�p�'ntF'.,<•�r.S'�3„��'S�n�a?'��.:;�.r f�;fK t-r �.,.
Name of Property Owner Requesting Permit W.
Mating Address:
o.�In -
Phone Number: a rT � D
Ernadl AdQress. [ �� ' � O � P `rS � r1G� • �(' 1(' • ��
i certify that 1 have authorized��t Agent/ Cortnictar
to act on my behalf, for the purpose of applying for and obtaining all CAM Perm's
necec�sary for the following proposed development:
at my property located at _
In V—�pr —County.
1 &ft,D evmwn9 cee*fy that I am authorized to grant, and do in fact grant permission to
Dev=iaa of Coastal Management staff, the Local Permit Officer and their agents to enter
on Ghe eforernendoned lands it connection with evaluating information related to this
POMW wpicadon.
prop ly Ow1w Wofmrtdan:
Sisr 70W ID
v,/ L+Itir,reAr5
ptrw or Type Name
P. e
Pop

r �.
a

ADJACENT RIPARLAN PROPIc0Tv OWNER STATEMENT t v►
I hereby certify that I own property adjacent to f�czr6ark 1=LoWe IR.-
(Nameproperly 4vne s --k- of Pr9portM Qes►�..,
located at i 1 ,
ddress, Lot, klock, Road. c.)'
on Sd- --nY) (4 , in - �,� , N.C.
1(Waterbod (C�t;Kwn and/or County)
The applicant has described to me. as shown below, the development proposed at the above
locatio
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)
WAIVER SECTION
I understand that a pier, dock. mooring pilings, boat ramp, breakwater. boathouse, lift, or groin
must be sot 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.)
y I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback roquirement.
(Property Owner Information) (Adjacent Property Owner Information)
�Q ar. S
rrtruc Sid; r rrr+ �.—•
✓b� /a 17lowcrs j i�a 1 W1L1..1 !lom' -S
print of Type Name PrY or T�e Name o ��� � L
SO O ( Q uG %lla�� Or
Mal nglti 4`isiNr�' Z � (o n 9 l�fyr dd
Crty/5t� R _g � _ Crty/St
`T id 300.3 A �,►
Telep neNumber/emadaddress Telephone Number/ emarladdress
(err l)urc •
(Revised Aug. 2014)
'Valid for one calendar year after signature'

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner Sarwrac r-1 o wers
Address of Property if 'Fn YISl Kira I 1 Or r vt A�laht� C l3PaCh; N� 7SS/,2
(Lot or Street #, Sbmt or Road, City b County)
Agent's Name #:
AgeM's Phone #.
Mailing Address:
t hereby certify that t own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the developmeat-...
they are proposing. A description or drawina with dimensions must be aroykied wi h this letter
I have no objections to this proposal. [ have objections to this proposal.
II you have otyectlons to what Is being proposed, you must nodfy the Division or Coastal Management
(DCM In wrftYng within 10 days of receipt of this notice. Contact lnfonnadon for DCM offices; Is
available ot htWYAvww.nccoastalmanagement.net/weblcm/staff-listing orby calling 1-88&4RCOAST.
No response Is considered the same as no oblectlon N you have been notified by Certftied Mall,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Pro rty Owner Infornwtbn)
Xgnrniure
a,� tiara F r o we rS ______
Print or Type Nerve
5001 Qua;l l�o(low Mailing Addfvss
Ta/ ►a, 1-7&0 , ---
5ry�s7
q 19 0 7& 30o3
re/r &Wv Number/Email Address
(Riparian Property fonnatlon)
�1' a,
Si e
J aavt n t dun .h
Print or Type Na
00 FOVES4
Mailing Address
/Atlahfi*c I3caC6' N6 nS12
cityistateizip
� /°)- 01G- �ob3
relepta umber mber / EmW Address
Date (Revised Aug. 2014)

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