Olde Towne Yacht Club

CAMA / '-I DREDGE & FILL V21
GENERAL PERMIT Previous permit #
'El New [:]Modification ElComplete Reissue Ll 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
❑ Rules attached
Affected D CW DEW [JJPTA EJ ES El PTS
AEC(s): El OEA El HHIF El 1H El UBA L1 N/A
El PWS: El FC:
ORW: yes / no PNA yes / no Crit.Halb. yes / no
Project Location: County__
Street Address/ State Road/ Lot #(s)
Subdivision
City— ZIP V
Phone# River Basin
jAdj. Wtr. Body'-6 (nat /man /unkn)
Closest Maj. Wtr. Body
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No
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer's Signature
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

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 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, certifythatthis 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 howto 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/ 1-888-4RCOAST
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

Michelle Johnson
On -Site Manager
100 Olde Towne Yacht Club Rd. Phone: [phone]
Beaufort, NC 28516 Fax: [phone]
[e-mail]

May 2114 02:07p Olde Towne Yacht Club 252-726-4916
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to 14�-P t n1 a wp- is ch:''F LVA 's
erne of Property
{er)
properly located at_ ,� `�i C` lAe 7bwv� NA �t.� "1�.�
(Address Ott, B Road, etr,)
' on JY W - A 6y o&% \ . In 1�wqw
(Wdy) (Clty/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
ltipn.
i have no objection to this proposal.
l have objections to this proposal.
p.1
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
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f WAIYER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 19 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' se$back requirement.
_ I do not wish to waive the 15' setback requirement.
(Property Owner tnfonnationt (Adjacent Property Owner Information)
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:ature Signature
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Date - Date SAY 21 2014
(Revised fJ9812pp12
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May 2114 02:07p Olde Towne Yacht Club
252-726-4916 p.2
AD,1g,CENT RIPARIAN PROPERTY Q VNER UATEMENT
i hereby certify that I own property adjacent to
property located at
on
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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
{lndlvldrtal propos/ng development must fill In descdptibn below or attach a site drawing)
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~' WAIVER 8ECTtON '
I understand that a pier, dodo, 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 I& setback requirement. .
f do not wish to waive the 15' setback requirement.
• t1Ay 21 2014
(Property Owner IMonmationj — • (Adjacent Property Owner Information]
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Tefshone Number wephone4Vurrrber
Date 1 '• hale
(Revised GMBl2012)