Crows Nest Yacht Club (2)

L CARs NJAII 1 pREDGE & FILL
GENERAL PERMIT Previous permit#
gNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental, concern pursuant to 15A NCAC ! i i I i 1 A
I 1 r Rules attached.
u4pplicant Name �, ' ► .f ' _ . •I `, f .' Project Location: County
ddress_r� t` i ?''�ni r 3�( `1 > + 1 t (-j Street Address/State Road/ Lot #(s) fr
City r'x%: ;i fi Elf , State ,Ir ZIP ,� ,, r tJ;_
Phone # ( ! ? {„ _ t=oily Fax # (_) Subdivision
t
Authorized Agent 1 1 4 t ! 3 City, ?— '�4 'i, , 1g; " ZIP r,
_ - - ., yr ,y_ i1 _.� ram,, - • ,, ,
Affected ❑ CW F] EW ❑ PTA [CBS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes /(no ) PNA yes / n� Crit.Hab. yes / no
Type of Project/ Activity.,,
\E`<i� J� .._;
Pier (dock) length t(? �il� %► {t: ;f
Platforms)
Finger pier(s)✓?
Groin length
lwmber
Bulkhead/,jtiprap length %1 7 \
avg distance offshore 1
max distance offshore r-
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing tt
Other
Shoreline Length ti 1 )
i SAV: not sure yes no
Sandbags: not sure yes no'
Moratorium: n/a yes no
Photos: yesno
? Waiver Attached yes fnoJ.
14r_4r.,.. 1 i .l: n .A/,^
Phone # ( 0.) '.X/-,_ j.j River Basin I (_.
Adj. Wtr. Body 1 "_' 1 ; in
Closest Maj. Wtr. Body
(Scale:
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A building permit may be required by:
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions i ?( 4.1,
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'Agent or Applicant P •nted Name
Permit9fficer's Signature
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Signature -y rM Please read compliance statement on back o{ pew it
,L1
Issuing Date
Expiration Date
lr
ApplicationFee(s)
Check#
Local PlanningJurisdiction
Rover File Name

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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 andvoid
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, 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 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 how to comply with 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/ 1-888ARCOAST
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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Applicant:
Date:
j V
Describe below the HABITAT isturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance.total
includes any
anticipated
restoration or
temp, impacts)
FINAL Sq. Ft.
(Anticipated. final
disturbance.
Excludes any
restoration
and/or temp
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
cts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
redge ❑ Fill)h Both ❑ Other ❑
Dredge ❑ Fill'[] Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both' ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
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Jan 11 1410;53a Craig Frey
. ,j ,
252-247-2360 p.1
Date
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
1—f3—zoa--
Name of Property Owner Applying for Permit:
Ma iin']g Addresss:,,
40 C
l certify that I have authorized (agent)1 f'YI �tiYS
�� �
x
r JAN 14 2014
DCM MO CITY
to act on my
behalf, for the purpose of applying for and obtaining all CARTA Permits necessary to
install or construct (actiNity) 4- a>a <k— '��-�►��d—��
at (my property located at) Ltd--7 �i-t-Lin,►-�'T� C., �tj b1
This certification is valid tbru (date) 2,— 3--- 2j=p 1 4
Property Owner Signs e �� s CGS )Ale, Date
L•d
EL£: L L 17L L L ULT,

Jan 09 14 11:34a Becky Couch 919-220-8079 p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent toWSO'S� ) 's
property located at X*U ( V'�-{-t.�l'-j-[ j C� `4� C.44 '- - - Sa
��7 ���� (Address, Lo� lock, Road, etc.) c�
on t-`SJ , in _ L`�-�-1 c C�bC , 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)
-,
J
RECEWED
JAN 14 2W4
DCMUM CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 16 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.
P' I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State)Zip
Telephone Number
natc,
Information)
J
Type riam r
Adoress
e�//ZZ1rrp��Ylr �1(� --�—
Telephpne Number L
vd � tfi
(Revised 6/1t1/2012)
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Print - Maps
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JAN 14 2014
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Jan 091412:42p
p.3
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT},
I hereby certify that I own property adjacent to �l�S "f�� 's
property located at CA —A"� 6L ` Lt` (- 3 `��J
{Address, Lo#-Bock, Road, etc.)
onPn�1�� , in L<
. 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)
v-
JAN 14 21114
ncv - SIu 3 et°t'l
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)
Signature
Print or Type Name
Mailing Address
City/Statelzip
Telephone Number
Date
(Adjacent Prope Owner Information)
SignatureL-o M ' 1 J,vl? V)
Print or Tye Alam .�--
MaAddr
t"rlSa7,l✓C'
citylstateizip�,
i-s�-;,7
Telephone Number
Date
(Revised 6/1fV2012)

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