Triple J. Hideaway, LLC

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4AMA / ❑ DREDGE & FILL
GENERAL PERMIT
F �•
ew ❑Modification []Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of I Environment and Natural Resources
Previous permit #
Date previous permit issued
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Tf � les attached.
Applicant e ` - (' " I �'. t" rW ��' Project Location: County e--y 4 r +'
Address r F— 7 .; t . r ? 1 ,' Street Address/ State Road/ Lot #(s)
Phone #
Authorized Agent
Affected Er4v �W —ElfTA
AEC(s): ElOEA ❑ HHF ElIH
❑ PWS:
ORW: yes (2 no PNA yes /
Type of Project/ Activity
State,Aw - ZIP
❑ ES ❑ PTS
❑ UBA ❑ N/A
0,Yf_1. r
✓fit Cr a.- C.. j.•/. p ' e� r{
4
City :i° e- 0 i r`. ZIP 6 ¢ /
Phone # ( ) River Basin
7 !
Adj. Wtr. Body rya man unkn
w�
,7
Closest Maj. Win Body % L r' <' w c r;•r,* ,
(Scale:, ... ) .
Pier (dock) length i Xi ...., j d'
Fixed Platform(s) X76
Floating Platform(s) "
Finger pier(s)
Groin length
number
Bulkhead/ Riprap. length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
MMM�mmIltimmmmmmmmi
Shoreline Length its —NEENNEEKIMENRENNNEWE
SAV: not sure yes Moratorium: n/a -®1■■1E1E1M1M®®:■■1WN■■■KI
1 ■1®1�Waiver Attached: yes (no
A building permit may be required by: C"'� �d ,a. ❑Seen to on back regarding River Basin rules.
( Note Local Planning Jurisdiction) rq r
Notes/ Special Conditions. R � t �"` ✓
o
Agent' or Applicant Printed Name PermitOfficer's Printed Name
Sir Please read compliance statement on back of permit Signatur
r'C1171
'�
r App tion;Fee(s) Check"# Issuing to EXpir tion ate .

r
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 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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
0 Other:
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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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.nccoastalmanagement.net/
Revised 08/27/ 14

AMA / ❑ DREDGE & FILL $� A B C D
GENERAL PERMIT Previous permit#
Flew ❑Modification ❑Complete Reissue . ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of grivironmental concern pursuant to I SA NCAC
ant Name I r i.ules attached.
re 4" Project Location: County �` 1"
s Street Address/ State Road/ Lot #(s)
If
State ZIP%
#' e)�1(7(9)k-Mail _ Subdivision
iietl Agent , r City % Crt ZIP f
d 1N �!iA p ES ❑ I?rS Phone # ( ) River Basin" g
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: Adj. Wtr. Body t;i t fIt` a Iman unkn
yes no' PNA yes / o Closest Maj. Wtr. Body
of.'Project/ Activityc .
r Q tares (Scale: )
I ock) length
max distance offshor
nel
bic yards
IN
�
�
not sure yes no
��
Is:'- yes t -- -
:r Attached: yes 1
(ding permit maybe required by: 0 Seen to on back regarding River Basin rules.
to Local Planning Jurisdiction) %
s/ Special Conditions C
14
icant Printed Name ' Permit6ffic s Printed Name
r lease read compliance statement on back of permit Signatur
tjionFee(s) ; Check# Issuing to Ex it
N
:)npate

Jun.14.,2016 06:51 AM JV Brockwell Trucking 9199423001 PAGE. 1/ 1
ft
AGEN, T AVTHORIZATIQj1t ORM FOR,PERMIT APPLIOT1013
Name of Property Owner Applying for Permit: L LC
Mailing address:
C hao l ff-ill VC 9-75-14
Telephone Number: �l
G�hs'r'✓'c�s �, o�
I certify that I have authorizedLa�h�� �d✓'i/Z (agent/contractvr),-79� . 32 `
to act on my behalf, for the purpose of applying an4_obtalning,-W LAMA permits
necessary for the proposed
at my property located at
This certification is valid through . / — -3 j - I j9 (date).
(Property Owner Information)
�-- �Slgna�tum gc4ez
Print or Type Name
Title, co. owner or trustee for property
Date
Telephone Number
hf f2Lz7� / ' f I'`�i � �s � �s��r' . Cole"?
Email Address
RECEIVED
JUN 2.3' 2016
DCM- MHD CITY
JUL 21 2016

i�,u•�v,` t <ri ► ►:ire F-�r�,ts i'r_•����t'�.�..► ��9YlyF►t ���1!_'r_► rrv�riv
- -- ` T�
i frbl'sr1y f..i'tlf% tff:A J frllr► plopt'll%:srSj ,fs!►i t`�.._...._. �r�t°._ .AQr�� _...J:..__..
(Warne of Prnprrr' W'Inor)
�: _.�L:d'Qi./_` 1.- �
Rlock, "..oaii., Pt(;
!�,raay�srnr�dy)(cftyl'i"own anrjlor C,cunel)
'r; a;i;:iif sr►t I►a ; llis crii;:�1 ire r1►c;, e. :;iivrrr► )vf, tilt.; j(:vtA(j rrjrnt propo-;ed of the a'nnve
�Jr�l�it7. /J
I ne+re no objerlion to tni , proposal.
E h;;�%rr3 objr r;lions to this firr�po;al.
MCRIPTION AHD/OFF DRA1/YING rJE= PRO{'r>>I:D DEVELOPMENT � r
'if
ldividual rfroposing d velal)went rnv:: f fill in dr 3cription below or attach a ;:ice dray- rgr) V
1 n S `i l X 1 7 0' hod Sla4 Qvc-�a c1'J1 0 r X Z4 r
2_ _� S�e-f5 .
RECEIVED
JUL % 12016
WAIVER SEMON DCM- IV HD CITY
urdarstoand that a pier, dock.., mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
-r►t;rt be sei baci, a minimum distance of 15' from my area of riparian access unless err I V D
.ram" (If ycsu .1rrsh to Waive the sefnac'r., you murti initial the appropriate blankbelotiv.)
do wish 10 Waive the 5 selbacr requirement. JUN 2 3 2016
q4
•rdo not v✓tsh to v/aive the 15' setback. requirement. D C M - M H D
(Prrsn2rt,t dvfner information) (y{djac t Pr en Owner information)
Si alure` L
4 � + t r, (3YQv►e N.
Dalz
l�
Print or Ty a fume
Mal ngA dtTwJL
�+�Z��
Cilyl lalelbp
Telephone Numherl marl address
L
Dal s
(Revised Aug. 2014)
CITY
-/ate ftir Ong cau%mr year afisr signature"

ADJACENT RIPARIAN PROPER't'y OWNER STATEMENT
I hereby certify that I own property adjacent to flati 1� �at k
(Name of rop rty Owner
property located at 0-7 C��,
_ / (Address, Lot, Block, Roa etc.)
on JG YV , in _ C a do<. Co 4 kT" . N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca_ dory
t have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(►ndlWdaaf proposing development must f/ll in description below or affach a site drawing)
7 n S +-0-4 V1 X I7 p' h10-7 5bvakt.AV-ZtJ q
l (I X 20' * L ", 4ef S
RECEIVED
JUL 21 2016
DCM- MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 16 setback requirement
(Pr*perty owner Information) (Adjacent Property Owner Information
or
mar mg Aaor rr , rrruy nuuZ
6.4
ZISE
City/State2ip w1slatelop I/ - n
700( w,reb�obe '7�b�o1!'�arl,enr "7-04-- SS`�Z-
Tele hone Number/emalf address Telephone umb r/emaff address
Date Dates RIECEIV5D
(Revised Aug. 2014)
*Valid for one calendar year after signature'
,1 U N 2 3 2 016
DCM- MHD CITY

6G ��- J a vr'�e �Q od r✓ �S
CONNECTGIS vse( /
WES HOSTING I
Excel 20002003
Address Score
1 107 INTRACOASTAL CT, 28584 99
2 41!�Z 107 INTRACOASTAL DR, 28516 88
RECEIVEL)
JUL 21 2016
ID M_ Mtn = �,. y
1:87
17 0 ' X y ' Wa Ik wA-)
20
.110m)
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