Starling, Bryan 78381C

r 1/ DREDGE & FlIL A BjJG3 D
PERMITPrevious permit #
l ew >� Modification .,Complete Reissue ...-Partial Reissue Date pr vious permic ed
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission ip area of environmental concern pursuant to I SA NO FP
/, ufes attac ' d
Applicant Name_ . ' � Project Location: County _f_
Address._...Street Address/ Scat pad/ Lot #(s)
City State.... l 1-71P ...r ..... ..._ 1 -
_ ...... i _ - _-...
Phone # ,. ) -Mai _ Subdivision .._ A_ _..._ _
- T- -,
Authorized Agent (. City.. ( ill'
Cw E 1V TA 7s E5 C PTS Phone # _,�wer Basin _.......... _
Affected OEA HH 1H UBA N/A act an
AEC(s): Adj. Wtr. Body..__. _ .�
LJ PW
_ Closest Maj. VJtr. Body
ORW: yes 1, b PNA yes J:
Phetos: yes no ?f
Waiver Attached: yes no �?j w
j ( { 1k
A building permit may be required is V a See note on back r gardtno River Basin rules.
Note Local Planning Jurisdiction) ! €'i �i I /r il, l` A I I t l Psl '
read compliance Statement on
Check #

-� CAMA / ❑ DREDGE & FILL �? % t A B6) D
ENERAL PERMIT Previous permit #
ew ❑Modification []Complete Reissue ❑Partial Reissue Date pr vious permit i ed
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission ir an area of environmental concern pursuant to 15A NCAC 9,
Rules attac ed.
Applicant Name Project Location: County
Address ' Street Add ess/ State oad/ Lot #(s)
City State ZIP
6JDhurn
V, J
Phone # ) -Maiji _ 4. Subdivision�� (� h nt�r�r�l
Affected
AEC(s):
❑ CW k EW LNOTA ❑ ES ❑ PTS Phone # WJ() �L1"/ n `)River Basin
❑ OEA
❑ UBA ❑ N/A
Adj. Wtr. Body

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 [)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 howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-41RCOAST
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

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
m �'����f�
Email Address: a
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA perm`
necessary for the following proposed develop7nt:
/?St-ay��`1-77DA,-\
at my property located at
in � .�-' County.
1 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.
Property Owner Information:
Signature
' 1
Print or Type Name
Title
/ )_ 5 / ZU
Date
This certification is valid through �"

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
� `� � ��
I hereby certify that I own property adjacent to � ,s
Name of Pro err Owner)
property located at
(Address, Lot, Block, Roa , etc.)
on �®ai�1�� C�<, ►n � Eoun
N.C.
(Waterbody) (City/Town and/or )
The applicant has described to me, as shown below, the development proposed at the above
location. ,A
�-_ 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 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 Info
Print or Type Name
12-1 5' S
Madina Address i
tion)
21
me Z?'S,S
CiV/State2ip
F' p 2t 2 0R !? q br-c/<po S (kr (iMaP(AQ. ca n
Telephon Nu ber /email address
Duce
(Adjace Property wner Information)
Sigfaature x
C -S-
Mailing Ad ress �l NC- Z S SS
�r
Citylsygiij Z 1 I
Telephone N mber / email address
Dute-
*Valid for one calendar year after signature`
(Revised Aug. 2014)

4(f

ADJACENT RIPARIAN PROPERTY OWNER STATEMENfi
r-17 -c-r4JPJ,S
I hereby certify that I own property adjacent to
Name of Pro a Owner)
property located at s 5
(Address, Lot, Block, Roa , etc.)
on�aa15 '>�G , in N.C.
(Waterbody) (City/Town and/or Coun )
The applicant has described to me, as shown below, the development proposed at the above
loc4tign IV'
lU 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 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 Informal (Adjacent Property Owner Informgtion)
rc'(') i (0 ( )hoc r—
e
Print or type Name S� '
1 LI '1
NC 21�55
ttylStatelZip ' '
I
1 D Z 12 09 ccni- ,, �M al`, 4 }rl
3�C� �rvK� �
Telepho Nu ber / mail address
04 Z 3 740 —
Date
gnal ure
M in ddress -! �1
I g) N 3p�r_
Ci�State/Zip r
Te/ephon� Num4er / email address
2 l ,f, o
Date
*Valid for one calendar year after signature*
(Revised Aug. 2014)

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