Beacons Reach Masters Assoc.

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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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
FA 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters.
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

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Wl Am!

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: bum,�s Q.acY. me--k.. Ayacc..
Mailing address:
Telephone Number:
? o .8-0Y WN
XT;L -;LIVi - I -to k17
10, C, 218i�i�
I certify that I have authorized - i F—.-�C, P .►,,- (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of Mc�.,,� o� Kt �eccmri5
fk**.d., 'r'& .,a C% C,i Aeyr c. It
at my property located at 5 to (Yl�•-••� �•V-c
This certification is valid through AAsn ts,"XoIS' (date).
(Property Owner Information)
l,J , r4--CL rer-
Signature
Print or Type Name
Title, co, owner or trustee for property
313tL 15-
Date .
:�, S I-Z4Z - `-lt) L,
Telephone Number
a ftA" .co'wx
email Address
RECEIVED
APR 0 7 2015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to Bugp'a R L%:, �ar. __'s
(Name of Property Owner)
prr�pr�cy Iauatrs fit_ - SqQ.... fY�er�•,ac,�...�,�,L _., _:::..
(Address, Lot, Block, Road, etc.).­....
tc.)_
on Z�- e_So,,--cA , in , N.C.
(Waterbody) (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.
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- .••09 .
Qe.v,a.i a.l�
Z�f
lc.s s tuv-, !, Doo
RECEIVED
APR 0 7 2015
DCM-MHD CITY
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 waivedby me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
i,1 ! A' 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)
3Jec,u�s R�c..d+�, Mo.►y.�o.
Signature Signature
(':!,o.c,.•, U ). �,ktyv_r S U-M d : m % krr AV%tx %-AA . mac.
Print or Type Name Print or Type Name
PLt..P..4 O8cl,, ��.Sow '701
Mailing Address Mailing Address
►4.1'Lo ._ "N l..�.`
City/State/Zip City/State/Zip
ASS-�.`It7-`Io�`j �51.• 1.y,'1 _ �SsbJ
Telephone Number Telephone Number
3313c, 1 45-
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to 3eac04s IMr,►-AIS 's
(Name of Property Owner)
poperty
(Address, Lot, Block, RoN.C.d,-etc.) ...._ _.....
on .�. 5�,.,,,� , in i�- ►cm%k Snow < , N•�
(lhlaterbody) (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.
I have objections to this proposal
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Ao „Wy---L� -r- k-e- P%o-r►-,- C.1tic.nrre.\ - 'Eros. +. "\C."'>
RECEIVED
APR 0 7 2n
DCM-MHt3 CITer
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.)
^� /A� I do wish to waive the 15' setback requirement.
I do not. wish to waive the 15' setback requirement.
(Property Owner Information)
0,
Si a ure
Print or Type Name
PO. Bcv. "Sci
Mailing Address
CitylStatelZip
Telephone Number
313o1,s
Date
Owner I
Print or Type Name
'P O. Bev. Imi S
Mailing Address
,►�tt..i� �tac�... nI .G '.L8S1 Z
City/StatelZip
OKA- 402-3���
Telephone Number
31--i"I ►r
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ .' e S Qe"—ck +�1cr�ao. I
(Name of Property Owner)
property_louat�; at S9� Mar.,.,s _ _
(Addiress, Lot, Block, Road, �e4c.)._... ...'."..�. .. _. , .._..._ .__.. _, .
on �ti- So.�cA , in F'Wv 5LIQI.% , N.C.
(Waterbody) (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.
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)
Mp".��wc�
dwe&�•,,� o� 1f_.
c.l wnntil
+tom ���;5 L
rv-%e'�
60'1"c.
ar-
000 C-14
RECEIVED
APR A 7 1015
I'if"}�A'AvACIAnI ?+a1fdY
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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
C.J. 0CL)L -, j ntwsw+e!^
�3caccy: R.� c-5..� Kla-�•a�
Nnature
_ e.�.i►-
Print or ype Name
PD.6C,4 q85
Mailing Address
l4-a•1 i%C- 6 .C,,01, C• 28s1t.
City/State/Zip
RS'2 - .14 7-`to t"I
Telephone Number
3t SCA it
Date
(Adjacent Property Owner Information)
&evacwur-r4xmtk% ILJe4�kxr}R.xYcp1t -LJ"
Sig tune
Q�e•w�-
y r
Print or Type Name
o (npa fl A- 4
Mailing Address
At" c. 8ea6, ^X 2,rn
City/State2ip
xn- 342- M22,1
Telephone Number
31-ac>k i-5-
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that. I own property adjacent to 's
(Name of Property Owner)
ro
p perry apa+.,ecs at-�
(,address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
RECEIVEQ
APR 0 7 1015
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.)
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 Name
Mailing Address
City/State/Zip
Telephone Number
Date
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to
(Name of Property Owner)
I
ert©�atecs at _ . . ,..... _ _... : _._,. .. � ... _ . .. .._.. , _.._,.._.�.,..._......,_...._s:.:...��.-......-.--,.,� .....,,..ten-�.,-.. _
(Address, Lot, dock, Road,"etc.)
on in , N.C.
(Waterbody) (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 proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development merit fill in description below or attach a site drawing)
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.)
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 Name
Mailing Address
City/State/Zip
Telephone Number
Date
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that. I own property adjacent to 's
(Name of Property Owner)
rtyJo_ca¢ecl at
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (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 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, 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) (Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 611812012)

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