Nguyen, Bo 78399C

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f,A44� A _! DREDGE & FILL #
✓: A B 'fCD
PERMIT Previous permit #
jNev1 ..:Partial Reissue Date previot s permit Issued
.Az st chc,ozed by the State o° North Carolina. Department of Env:ronmentai Quality .. Y
and ,he Coastal Resources Cnmmissia i an area of environmental concern pursuant to 15A NCAC
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Applicant Names �� t3t�i �J2_K 1 �-._._.............. Project Location: Coumy, . _�� 't � �� ........ ........
Street Addressl State Roadl Lot #fsl
' Exoirationf-wP
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AMA / ❑ DREDGE & FILL
EN ERAL PERMIT Previous permit #
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previo s permit issued
ed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
R les attacheA.
Applicant Name 1 NO"I 1 Project Location: County
Address I V 1C11 41Street Address/ State Road Lot #(s
City W - State ZIP
Phone #) E-Mail Subdivi io
Authorized Agent City ZIP
Affected ❑ CW EW TA ❑ ES ❑ PTS one # ( River Basin
AEC(s): El OEA ❑ HHF ❑ I ❑ USA ❑ N/A Adj. Wtr. Body at / an /unkn
❑ P S:
ORW: yes / PNA yes / Closest Maj. Wtr. BodyF? I---
Type of Project/ Activity a �J qL pZlj�A 7 kt(

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 I) 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 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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

c,k AGENT AUTHORIZATION FOR CAMA PERMIT, APPLICATION
a 978
Name of Property Owner Requesting Permit: -0rr
Mailing Address: ,J
Phone Number;
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ��-
(�
Gt G ry O
at my property located at U
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:
I L4,-,
Signature
V �jC
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Print or Ty e Name
Title
Date
This certification is valid throughl��l,
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RECEIVED
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to BOCL u e- 'J --- s
(Narnerof Property Owner)
property located at
Phddress, Lot lock, Rota, etc.
on in �� �c IV Cf"�( N.C.
( aterbody) (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.
have objections to this-pr-op.os.al_.__._._.-_ _ __...--_---
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deve o menf m st fili ' c 'ption b ow or attach a site drawing)
for s
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_ 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 rust 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)
Signature
Print or Type Namd
Maying Address
j. A, N (� ),- -Y <�2
City/Staje/Zip
Telephone Number
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Signature
Print or Type Name
Mailing Address RECEIVED
City/StatelZip FEB 2 4 Z021
Telephone Nuinber
DCM-MMD CITY
Date
Date
(Revised 6118/2012)

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ADJACENT RIPARIAN PROPERTY ®WNES►A EMENT
I hereby certify that I own property adjacent to /,�Odl Qam-e
f Prvpei�i�f O�a�+ner)
properly located at 201 ��t>� ��a- � /'
(74ddress, Lott loch, Road, etc.
on 0"o' in - . L L e lUC i�i.C.
(1 Jaterbody) (City/iowrn and/ County)
The applicant has described to me, as shown below, the development proposed at the above
location. it
i have no object • �� "� ,r r'
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Mailino'Address A ( Mailing Address
City/Sta elzip City/State/Zip RECEIVED
Telephone Number Telephone Number
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(Devised 611812012)

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Styron, Heather M.
From: Thomas Lawrence <[e-mail]>
Sent: Saturday, February 20, 2021 11:04 AM
To: Styron, Heather M.; thomas lawrence
Subject: [External] 201 Moonlight drive
Attachments: Scan_20210220.pdf, Scan_20210220 (2).pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Here are the two riparian forms with 15 ft waivers. thanks Thomas Lawrence

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to '04 u V kI - $
- (N a of roperty Owner)
property located at G
(Acffiress, Lot, Block, Roac tc.) t; S 2
on W ov7x, : } e �. in 4 a _ &" �J C.
(Waterbo y) (City/Town and/a County
The appl' ant has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
------____-• I hav_�.ohje�tioas�o_thi _prolzos�l____---------------_.-.- _-- .
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
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bA 15Rfit- p
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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.)
Who I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
(Pro_pqrty Owner Information)
(Adjacent Property Owner Information)
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Sign- e !
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Signa�
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Print or Type n�al
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Print or Type Name
Me fing•A ress
Nt wyea t- A), 4C ,A
MailingAddress
Avi�„ b i. 5 e
Cif /Stateop.
ity/State/Zip
5J. 41 1- 19 34
71(- --b-15+0
Telephone Number
Telephone Number
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1)nte
Date
' (Revised 6/18/2012)

Agent's Name #: _ T Mailing Address:
Agent's phone #
I hereby certify that I 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 development
they are proposing , d sririo6on�'o��i �}u�dih "e""ris�ons t �i!'st�b uidedQWYVfM�-
.0 I have no objections to this proposal. I have objections to this proposal.
W you have objections to what is being proposed, you mustnotifythe Division ofCaasfalManagement
(DCM) in writing within 10 days of receipt of this notice. Correspdndence should be mailed to 400
CornmerceAve„Morehead City, NC, 28567. DCMrepresentativescanalsobeconfactedat(262)808-
2808 Noresponseisconsidered thesameasnooNectionifyouhavebeennotifiedbyCeltffled[hall.
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.)
ok�_ I do vAAsh to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
tProperty Owner Information) (AdjacentPropertyOwner Information)
Signature
Print or pe Name
I�,keY-
Y'
Mailing Address
N 1rV1a�
' N c, ate( �( o 3
City/State .ip
Telephone Number
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c;k AGENT AUTHORIZATION FOR LAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: ck
Mailing Address: A- j
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at � v
in _� County.
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1 furthermore certify that .1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Pennit Officer and their agents to enter
on the aforementioned. lands in connection with evaluating information related to this
permit application. - -
Property Owner Information:
t _ Signature
Print or Tye Name
Title
_ua
Date
This certification is valid through. r
Qa $a�
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RECEIVED
FEB 2 4 2021
DCM-MHD Clip

ADJACENT RIPARIAN PROPERTY OWNEIt STATEMENT
I hereby certify that I own property adjacent to 230al.
(Na' me f Properbj Owner)
property located at ,2o f
(Address, Lot Block, Road, etce
on MOK in (L4.C.
( aterbody) (CitylTown 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 ®RAIDING OF PROPOSED DEVELOPMENT
(individual proposing deve ® rneni miqstfill C t' to ID ow or attach a site drawing)
fort k- g C341
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tvi s ITrfa-Lr 9
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WAI ER 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.
(Proper�y Owner Information) (Adjacent Properlbj Owner inform, aiiion)
P,
Signature - 1
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Print or Type Wamd
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City/Stye ip.
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Telephone Number
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Signature
Print or Type Name
Mailing Address RECEIVED
City/State2ip
FEB 2 4 2027
Telephone Number
u..
Date
(Revised 611812012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMEW
I hereby certify that I own property adjacent to oat &(4,16AW ehu
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property located at-,20(
(,lAdress, Lot Block, Roadetc.
on wf� 41" in 4i 7,0.
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The applicant has described to me, as shown below, the development proposed at t,,I
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I have no object G
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CitylStatelZip
Telephone Number
Date
RECEIVED
FEB 2 4 2021
OCIM-IIHD CITY
(Revised 611812012)