Marion, Bryan 80690C

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/C REDGE & FILL _.�9 80690 A B �D
F L PERMIT Previous permit #
lNew ❑Modification []Complete Reissue El Partial RF Date previous permit issued
As authorized 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�T I �J
!� ❑ Rleys attache .
Applicant Namebl�Avd--,-,inWI Project Location: County C
� / ►�`H�A Q
• •. .► .1. oE-Vail
Authorized Agent
Affected ❑ Cw ,XEW XPYA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes / Lf> PNA yes /
Type of Project/ Activity �t�
Pier (dock) length & �(� `P1;JV' v i
Fixed Platform(s) 'W "
Floating Platform s) � X r7
Finger pier(s) 4T
Groin length
r
B khead/ � iprap length
avg distance offshore
max distance offshor
Basin, channel
.
cubic yards
Boat ramp
Beach Bulldozing
Other Pfi►f-VV A— J
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions �►r�{�p�
Printed
XES ❑ PTS
❑ U BA ❑ N/A
Si ature **Ptb?se read compliance statement on back of permit
----� -; q.- aq
Application Fee(s) Check #
St re t Address/ S ate Road/ Lot #(s)
Subdivision -
City ZIP
Phone # ( ) . River Basin
Adj. Wtr. Body rQ�i9�/1��i1/a %/ i e at Dman /unkn)
Closest Maj. Wtr. Body
(Scale: I�� i )
❑ See note on back regarding River Basin rules.
Signature " r
g11 /a21 1 /i AR
Issuing 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 [)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 howto 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 - (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
Name of Property Owner Requesting Permit: �e�a,. A2� o _J
Mailing Address: '<f oo,.a r_2- s � T ;
_7���''7
Phone Number: (V" — S t
Email Address: L0,-.) 1 I,Z t � ('
I certify that I have authorized 600a"
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: L4_ c
C D G1/ q"-•) b a-74 it R- ( r, k ICE lv
at my property located at ) 1 6t S • S'P VIVG'_ cS _
in �'�'" County.
1 furthermore certify that l 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:
Signafure-
qN _� /_�4Q_( o. __�
rint or Type Name
OW ti cc L.__
Title
1 � � / '2- `,
Date
This certification is valid through % / I I / ? —

9.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A W ►J \ NI01 A/A t`,. (AAmA t�- 's
(Name of Property Owner)
property located at 1 I S s - '� %v0-)6k- -� t ?
r�I
(Address, Lot, Block, Road, etc.)
on , in /4 yQ,/-l4,!5 41�,- C 7-1 N.C.
(Waterbody) (City/Town and/or Co nty)
The applicant has described to me, as shown below, the development proposed at the above
loc tiQ
/ 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)
S 6 Z A ITAe4)\' '{
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.
d I do not wish to waive the 15' setback requirement.
(Pro a Owner Information)
S1ncrfure
'j Z VA--.J L. M 4 '- i o. J
Print or type Name
/l � S. S/./)ao,U fT-
Mailing Address
���4 Lai. c�����F.SS'�
CityCity/Statep� ���t�(Z� a..► Ia..►
.S"�o-��('-�ISt I�GMar4
Telephone Nurnber / en ail address C o
P- //-A\
Dare
(Adjacent Property Owner Information)
Sign'Nure *
/ V , M, 4 1ILL
Print Type flame —�
Mailing AddrMailing Addr s
City/State/Zip
Telephone Number/email a Tess
Date*
(Revised Aug. 201 4)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to "6R-yA� ST_A?-1,k J C.0 s
property located at /.Z. \ S S'Poo '1 45 s S ; (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on �Po,,., � C s (19,6 E 14/r= in 'mil 0 rL< e'& t" N.C.
(Waterbody) (City/Town and/or C unty)
The applicant has described to me, as shown below, the development proposed at the above
loc tion_
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)
5�� 1, � Lf
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.
(P7 Owner Information)
51�,17QI ure
Print & Type Name
IN s . SP©)'Jd- % �; .
Mailing Addr ss
City/State/Zip I,A.c,H
Teleph � ne Number / ernai address
r _ //^ \
Dale
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
.Si Al bf f'e*
i
7
Print or Ty e Name
S Srt vo« J
Mailinp Add ess —
,mo z� 2 S 5
City/State/Zip i
Telephone N nber/email address
Date*
(Revised Aug. 2014)

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