Triple S. Marina

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❑ CAMA I DREDGE & FILL T57 j
i 2 4(_
GENERAL PERMIT Previous permit#
❑New 1 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 concern pursuant to 15A NCAC
D Rules attached.
Applicant Name Project Location: County_ �-- 14
Address Street Address/ State Road/ Lot #(s) i� S J
City
- -- > 'l
-- State ZIP ,--.
Phone # ( ) : ' Fax #
Subdivision
Authorized Agent city `; 1' ; f. (; ZIP �c
--
Affected CW 7-EW PTA __ ES PTS Phone # ( )�� ��'� ;' River Basin
s OEA HHF UBA N/A
AEC: _ PWS: —,IH 'FC: Adj . Wtr. Body (nat /man /unkn)
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Shoreline Length _
SAV: not sure
yes
no
Sandbags: not sure
yes
nc
Moratorium: n/a
yes
na=
Photos:
yes
Waiver Attached:
ves
na
A building permit may be required by: A i See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant
Signature "Please read compliance statement on back of permit"
PermitOfficer's Signature
Issuing Date Expiration Date
ApplicationFee(s) Check# Local Planning Jurisdiction 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
nullandvoid.
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 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/ 1-8884RCOAST
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

GP Habitat Sheet
Name: Triple S Marina Permit #: 65257C
Date: 10/9/14 Address: 1511 East Fort Macon Rd.
Habitat
SF of Disturbance
SF of Disturbance
LF of Disturbance
LF of Disturbance
Open water
276
276
n/a
n/a
RECEIVED
OCT ) 0 2014
DCM-WO COY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
r
I hereby certify that I own property adjacent to _ 1Z i ,p ) rn a� Q 1 dJ is
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on a'Sv11_VD , 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.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
RECEIVED
f
OCT 0 8 2014
n DCM-MHD CITY
WAIVER SECTION,.%
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back aminimum '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.)
RECEIVED
l do wish to waive the 15' setback requirement. OCT 10 2014
I do not wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner Information) (Adjacent Property Owner Information)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to TR- t D ) c -5 m 4 !L t cvrf 's
(Name of Proper Owner)
� property located at �� a'm4e-�K R-1 1 v'Z�
y (Address, Lot Block, Road, etc.)
on ,,in PI- A-w4-t'cl wId c , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
�ation.
have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill 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.) RECEIVED
�+ I do wish to waive the 15' setback requirement. OCT 0 8 2014
I do not wish to waive the 15' setback requirement. I j ACM-MHD CITY
(P7;d
rty Owner Information)
l ^ . C.Jtq*-f'� [
a, rune
riun ►� Ne�vai{�e �S// !Y►y&Rz-
Mail�g�Addres�i a
City/State/Zip
� V
Telephone Number
.2 47- 43.3
Date �.' j. 1` n
Owner Information) RECEIVED
Signature
rnnr or type ivn� � �� ^�
-_- ) 2-? y s , V
Mailing Add ess
City/State/Zip
OCT 10 2014
DCM-UHD CITY
Telephone Number
72
Date j
�IgI�
1 (Revised 61I M012)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) V Pj UG�C,� I �`, �s 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) YY) nco� 6i� vti
This certification is valid thru (date) RECEIVED
OCT 110 1"4°
DCM;MHD GI';,
Property Owner Signature Date