Pensacola Yacht Club, LLC

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"LAMA / LDREDGE.& FILL)
GENERAL PERMIT Previous permit #
.New" ❑Modification ❑Complete Reissue ❑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 c�ntcern pursuant to I SA NCAC
yi A ules attached.
Applicant Name A a tIA (i #r roject Location: County C 2 T ?.` '
Addressor ,� Street Address/ State Road/ Lot #(s) AO/ , ;gyp,, w4 A (/,e.,�,.
City State_ zip �✓►i"%'��r� f cato Ave
Phone # (�t 04 " Subdivision
Authorized Agent ! r"'2 City ZIP_ 2
Affected 1-1Cw l w A ES El Phone # ( ) River Basin 6 9; '6P
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/AAEC-, �,,
{) ❑ PW9. Adj. Wtr. Body/,�G �� a �--� hat /man /unkn)
ORW: yes / PNA yes / Closest Maj. Win Body
Type of Project/ Act! ityt
HMO- 21511,12
IN
.rrr
NOW,
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Shoreline Length 75
SAV: not sure yes no
E".
Moratorium: n/a yes
Photos: "dyes
Waiver Attached: lR!/Iyyes no �q /
A building permit may be required by:
( Note Local Planning"jurisdiction
Notes/ Special Conditions ] ®�/C ve &p
SigaafGure
Application Fe
E-MMM
E-MMM
V I— LJ
cant Printed Name
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Permit 's P nted ame {
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ifl'easrea� p�ian estatemenrni tonbackofpe t . -
Signature
DC
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(s)
Chet .#
Issuing p to
xpi ation Date
r

e
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 officerwhen 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
landowners).
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 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

AMA / N"'DREDGE.& FILL
"
GENERAL PERMIT - Previous
permit#
ONew. ❑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 cc;ern'p want to 15A NCAC�,'
Eii ules
attached.
Applicant Name e, . 5'4 Cato '\�� Cta4 ject Location: County
Address 0 5� Street Address/ State Road/ Lot #(s)
City ,&&6State Air ZIPy cc, [4 A W-
Phone # (f -Mail Subdivision
Authorized Agent f a i�g� Ci rhe� � # 1
ZIP 2 � �-
Affected ElCW C W aTA ElES ElPTS Phone # ( ) t River Basin t -,lV 6 )r
❑ OEA O HHF ❑ IH ❑ UBA ❑ N/A
AEC(s), - Adj. Wtr. Body 46 714eA �
n O/man /unkn)
❑ PVVs:
ORW: yes /�o PNA yes / Closest Maj. Wtr. Body-�
Type of Project/ Activity ` ��✓
Pier (dock) length
Fixed Platform(s) .
Floating Platform(s)
Finger, piers) ,--�
Groin length
number «+''
Bulkhead/ Riprap length
avg distance offshore
max distance offshore O'
Basin, channel 14),%WfA; 61
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
ApplicationFee(s)
/ �► �'' Lssrry
k - (Scale: V-r3 )
L)I I- I
❑ See note on back regarding River Basinrules.
�E��alttd-ra
srl
Permit 's P anted Name
tement on back of permit
Signature
/30/ 3
Chec # Issuing D to xpiration Date

ConnectGIS Feature Report Page 1 of 1
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ted December 29,2016CONNECTGIJ Prin
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__ Address Points fpsr.AA
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Parcels -Updated 12-15-2016
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Centerlines
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information displayed by this website is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and other
Tic records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for verification of
information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does not guarantee thal
data and map services will be available to users without interruption or error. Furthermore, Carteret County, maymordf or remove map services and access methods al
DEC 2 9 2016
U-0
https:Hcarteret.connectgis.com/DownloadFile.ashx?i=_ags_mapc6fpQ 1'e864a4'g6eS8TY 12/29/2016

ADJACENT RIPARIAN PROPERTY QWN011STATEMENT
hereby certify that l'own. property adjacent.to
property located atOF f (D%rn�e�qf.poppy. Ow er) .
(Address, Lot, Bloch
on '�= in
/Town an .or. Co.. nty). _.
The applicant has described to ine,: as• shown beloW, the. development proposed at the above.
locatro
.
=1 F have no *eotion to .this proposal: .
( have obteofions to this proposal
DESCRtPT101� ANDlOR QRA' (tNQ OF i ROPOS9 .DEVELOPMIENT,
`(Individual proposing d velopmeflt must file m descrip#lon below or attach a the drawing)
L
1
IV LE D
JAN 0 9- 2017
DC �- PAHD CITY
' k
.. WAIVER SCiT1AN .
r•:. ' •� .
understand :that; aierF deck, trioormg pi(ms,Threakwater, boathouse; Gift,- or groin ,must be set ' ... --
bacic a tnmirr um distance .of 5-,-from rriy area of rib. ian access unless waived by me. (If you.
wish to waweahe setback; :you must Inittil the. appr0p60te' blat�kbelow.)
' I do wish. to Wave tf e 1 �'setbaok requirement.
do 'riot wish to waive the 16' Setback requirement.
j
(Property Owner information) ; (Adjacent rope Owner rotor"matior�)
::, ;•
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v
Sigha. tore r
Print.or7ype Nama Q Print:or Type -Name
:.j _
Ma/n g Add. s .. Mailing Address
• ,..: , w �_ ...., ...., .. , � �..AC .. I�.-C.Q.: C, +� �• �%� 'Z.� SSA
.:.
-
lstatel2i.
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Te)ephon Num er - EC �%
riate Date �__ _ DEC 2 9.
2-016 i - "
:. (Revised 6A)Bkj- M H
® CrT y

. Pro ert Owner Information '
W Y ). (Adjacent Property Owner Information)
Signature : Signature . a
Pnnt•orType'Name" Print.orzlzY e e .f -
Nlar7lggAddress ^ M. W in ddras G -;
Y�
Y /gyp �ity/Stai _ S —
�. T26 -a
Telephone Number, : - _ _.. r66' h ne Number
RECEIVE7
C!
Date Date 3
nFC 2 9 2016 .
(Revised 6/18/20.
DCM- MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:_ ( 1�
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: i k,-re,4 4,,l c.
at my property located at
inCounty.
�e A
I 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:
�i
Signature
L �' - & 14
�.
Print or Type Name
O C )d�_J
Title
-'/Z— i2Fl2�_
Date
This certification is valid through I I
RECEIVED.
JAN 0 9 2017
RECEIVE
DEC 2 9 20ia
DCM- MH,t.) C IT

- N.C. DIVISION OF COASTAL MANAGEMENT
�..._a_._ AGENT AUTHORIZATION FORM
Date '
Name of Property Owner Applying for Permit:
Mailing Address:
i�Oyl, 2-TUSD
I certify that I have authorized (agent) "� k , , to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)�VL
This certification is valid thru (date) C - 20- Fl-
4
perty Owner Signature
RECEWED
DEC 2 9 2016
DCM- MHD - 11 FY
. C N®
JAN 0 9 2017
®CNI-
Date
u
Y 2
2 16
DC
DIT

v + �
Pensacola Yacht Club, LLC
1708 US Highway 70 E
New Bern, NC 28650
To Whom It May Concern:
Pensacola Yacht Club, the entity applying for a CAMA Major Development Permit
Application for improvements in the Pelletier Creek Channel do recognize Timothy
D. Powell as the authorized agent for this project.
Kimlberly Elliott
Registered Agent, Pensacola Yacht Club, LLC
Timothy D. Powell
Member Manager, Pensacola Yacht Club, LLC
Date
Date
RECEIVED
DEC 2 9 Z016
RECEIVED
JAN 0 9 2017
DD dal- NN D CITY
MA�` .2 0 2016
DCM- M
H D CITY OM- " T Y