Brown, Richard 79665C

CAMA /�&L
REDGE&FILL W 79665 A B /� D
,CpENE PERMIT Previous permit # l/
Lr ew OModification C1Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
Application Fee(s)

i
AMA / 1 DREDGE & FILL N9 7966') A B D
ENERAL PERMIT Previous permit#
ew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality (� ,
and the Coastal Reso ces Commission in an area of environmental concern pursuant to 15A NCAC
Rules attac ed.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot (s)
City I State Yv IP
Phone #) E-Mail — Subdivision
Authorized `A,rgent City' ZIP
ll CW W PTA Li ES [IPTS Phone # ( �Q_IRiver Basin
Affected [1TT❑TVVVriOEA111HFH❑ UBA [IN/A
AEC(s): Adj. Wtr. Body (nat /man unkn
❑ PWS: ,,
�....., , d _... ) Closest Maj. Wtr. Body's U 4_a "=_
Q
or Applicant Printed Name
Pri
lam.
Signature * ase read compliance statementop back of permit ** S
(Z2 i
Application Fee(s) Check # 1'
Date

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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ti j c1 ot r L �Emwg `-)2 's
property located at �� C l (�� f me of Property Owner)
(Address, Lot, Plock, Road, etc.)
on L Oe4 tl.Q_ in Aw LJ Qnr+ N.C.
(Waterbody) (ity/Town and/or County)
he applicant has described to me, as shown below, the development proposed at the above
r
� `/-- 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)
t� S `
�-�e ��� �� ��ss ��c � �k—
t�er- G� � �
sJ Jain t,n��-►'t,� t-�0
weU
WAIVER SECTION Tr�,}-c C'kDo
1 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 ou v0ph 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.
Pr peOwner Information)
�
Z S' �tCQre
arJ L J
2,
Print or Typ® Name
Mailing Address c ` c Zo 5 S 1-
City/Sy.taltRip (yl� of l 3 3 IV
Telephone Number/email address
Date
(Adjacent Property Owner Information)
J
S'
Print or Tvpe Name .
Cling Address
ty/State/ ipJ
Lc
elepber/email address
77
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*
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k
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
r I ot1 b`Y' cs}rtifV that 1 own property adjacent to .i' �Vor (o � �v� Jib
—._ s
Name of Property Owner)
property k,ratE}rT _i at _ _—� � l �
-- ,_ � I4 r, --
j (Address_, Lot, plock, Roars, etc.) �
f On -- 1` ,z^°__ in s L,,j_ nL(- - N.C.
(Waterbody) ( IC ty/Town and/or County) —
The applicant has described to me, as shown below, the development proposed at the above
loevtiot;�.
I have no objection to this proposal.
1 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)
t
C9
Ill
t
1<, tlCl-��t��, -�.��� kr�,
r vEAI p R SECTION
I{)N Tce
I understand that a ttt�� I p1,1 V, ' goat rarnp, breakwater, boathouse, lift, or groin
n1U t bo set back a millirw1 �.4 )i �+' hurn my area of riparian access unless waived by
�
rile, (if you wish to warvt. p,tist initial the appropriate blank below.)
t1C? ����is;l1 �r?>,�dzr,V }; t�trr.�<<k rt,p,rirPment.
i s€sede,v �rvyao�.i �w/k�ie»ol
I do not v` i,,ch to �; ilvt "I1(s 1:> S('.iback rf',CIUIrErTrent.
(C'r 3pesty Owr)e*r infortn atio) (Adjac rat Property Owner Information)
tire,, r{trt I 1 ®<i40 A_'',,�"
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rl'' I.� r'- IV"rlrrlE �
Print or Type Narrle
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�..I' Gity/Stalelzip� — ,✓to,'tre
Telephone Number / email address
N(Irr b r , email a�/d -SS
(Revised Aug. 2014)
valid fo1 on{, Caluildclr }t'Fir t3ltt.r 5i�rnc7tUr4
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