501 14th St, LLC 80684C

L AMA / DREDGE & FILL 9 80684 A B � b
ENE. L PERMS i Previous permit#
�l
ew DModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality "74 &10
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
j � % j Rules atta hed.
Applicant Name J"w lJ. Project Location: County �V O
Address Id . Street Address/ State Roja/Lo )
City .. State ZIP, �2-7� /
Phone
Authorized Agent
Affected ❑ CW 1W LA �ES ❑ PTS
AEC(s): ElOEA ❑ HHF ❑ IHt UBA ❑ N/A
❑ PWS:. .M,
ORW: yes / r� j` PNA yes /
Type of Project/ /Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s) --�
Finger pier(s)--�
Groin length
BZIler
ead/ iprap length
avg distance offshore I
max distance offshore'
Basin, channel
cubic yards _
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing -
Other
Shoreline Length
SAV: not sure yes o -
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning jurisdiction) ti
Notes/ Special Con itions
L
Subdivision
City
Phony # 9!q)"
Adj. Wtr. Body
Closest Maj. Wtr. Body —
ZIP
Basin
(Scale: ✓ )
❑ See note on back regarding River Basin rules.
Sign toe ** Pleas d compliance statement on back of permit" Signatur
Application Fee(s) Check # Issu ng Date Expiration 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 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, 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 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/ 1-888-4RCOAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
50 54-
(-C
Owner Requesting Permit: &ee\l`C ' _` °f O �
Name of Property q g
Mailing Address:
Phone Number:
Email Address:
I certify that i have authorized
3 00 s t o U sJ-Z�),,J f.3Ot-/N c,+�
c4A-fz�,t r-_ jJ e,- 2 8,;?- 76
D4 1 � 5 533
e/ y,,� I'f17 e 5�1( . (aA't
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: R MLI'1 �4—p
at my property located at 50
in Ct?-eT_74Cr 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:
AJJ1,4A ",d4 Atet�
Signature
'e'Y"/-0 1 ' ar- �
Print or Type Name
Title
9-6 R1
Date
This certification is valid through / 7,-/ _�' ( / ;2-y2_ 1

To; 2527263765 From; 7048178144 5-06-21 12;04pm P. 1 of 1
May �Ub eUZ1 1U,49A!11 the Webb Ubrary 2527263765 page 1
W.ACE T RIP RI N PitOpEgn OWNIEL S/TATPMENT
I hereby certify that I own properly adjacent to �Q.Kt �„� c�7 . n'I A P/ Q 44;e, 'e
(Name of Property Ow )
property located at � q#,
�C9 (Addrass, Lot, WocJ, Ro d, C#, liar N.C,
an _
(Warterbody) (City/Town anWor County)
i
F71
sdescribed to me, as shown below, the development proposed at the above
ave no objection to this proposal.
I have objections to this pmpoeai.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
{d>t�J':�q�pp�px/ram �nAs�ME��tusf }4(h`l'r� �ic�pi�q�t'� dildiwG� +l��It� dfiewtn�►)
D
WAlyABSEc�N
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must bs set; beck a minimum distance of 16' from my area of riparian ecoess unless waived by
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
I do wish to wait® the 16' setback requirement.
not wish to waive the 15' setback requirement.
(Property Owner Information)
'34'"ururu A L
r
Typhon® Number/4emall address
D�
ll%'grMA r W"%"^®
Owner Information)
Pr►nC/ S 7Yxse ►V� . e
C`%-c)
"7 7 / U` U e V ,'
Telephone N Tberl email eddrese
��GI_at/PC �oZ
(Revised Aug. 2014)
NI

is

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i GtrC s
(Name of Property Owner)
property located at Z 54r4E,
;�
(Address, Lot, Block, Road, a c.)
on u � � in r 2 `y' N.C.
(Waterbody) (CitylTown a i®r County)
The applicant has described to me, as shown below, the development proposed at the above
location.
} I have no objection to this proposal.
N v 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)
. n
o �
hVI C_
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 Information)
i Qat�ure(�/ J�
Print or Type Name
/ email address
te11(` CO/
Date
p "*��aaI'd f r one c r-s�9V�*
**'lid Por one c��r r
Properly ,caner Information)
u�ryiaraeei�ip `y </
Telephone Nu fnber I email address
Dater
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to : r of C s
(Name of Property Owner)
property located at D S .
(Address, Lot, Block, Road, a c.)
on SO U 4p— , in r 2 , N.C.
—� (Waterbody) (City/Town a /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.
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
Tz) .
o
1/10 C-
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 Information)
(-�ighature
Print or Type Name
Mailing Address
Telephone Number/email address
Date '� l
:J*�aI'd fpor one c ii r r r Ji�Wllill
Va�id
m)
City/State/Zip
Telephone Nu ber / email address Q Cheo�
Date"-�- RECEIVED
(Revised Aug. 2014)
MAY 10 ZOZ1
DCM-MHD CITY

,, ,
a ,

Tay 2527263765 From: 7048178144 5-06-21 12;04pm P. 1 of 1
May Ub 2t121 1U49AM fhe Webb lbrary 2527263765 page 1 i
&�tLACgNl RIPAatAN PB OE U OWNER 4/T�ATEMENT
I hereby Gerrity that I own property adjacent to
((Nome of Property Ow
property located at
on �1Qt�� �ddroas. r CJc, R I
In !V , N.G.
(1Naterbody) (CltyRowtr anwor County)
i
FIcant��71
s described to me, as shown below, the development proposed at fhe above
ave no objection to this proposal.
1 have objections to this proposes.
IPn11gII���Y. IIIIY��I II���IVI
I DESCRIPTION AND/OR DRAWING OF PROPOSED DEVI?I.dPMENT
f�J;ai�w+a�r �pviato�,lrtithl�mw�t-illll'rrt �a� a�+ �stt� d�
Uel
WA]YAB SEAM
I understand that a pier, dock, mooring pilings, boat romp, breakwater, boathouse, lift, or grin
must be set back q minlmurn distance of 16 from my area of riparian ecom unless waived by
me. (if you wish to waive the aMbeck, you must Initial the appmprlate blank below.)
I do wish to waive the 161 setback requImment,
do not wish to waive the 15' setback requirement.
(Property Owner Information) (h rty Owner Information)
/. —
74
Prn pe Aisma -Pdn I�eme
..ram ✓� I c & r -2 a �-
elephone Number/arna0 add"
I/
VaNdUr M A r W *�*W
Telephone NNrrrDer�ernall address
Dare .�b
(R®v*ed Aug 2014)
REC IVED
MAY 10 2021
DCM-MHD CITY

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