Dockside LLC

ON
CAMA / ❑DREDGE & FILL
No 70939 A B C D
W��NERAL PERMIT Previous permit#
❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental oncern pur uant to 15A NCAC t !
❑ Rules attached.
�7 Project Lation: County
'
Applicant Name i
—�'" � � .1 ty
Address w Street Address/ State Road/ Lot #(s)_%!
t
City State ZIP
Phone # ( )
Authorized Agent
❑ CW ❑ EW
Affected ❑ OEA ElHHF
AEC(s):
❑ PWS:
E-Mail
gPTA ❑ ES ❑ PTS
❑IH ❑USA ❑N/A
Subdivision
City
t t � � r' _t='ftl�;, ZIP_",�.._
Phone # ( .:) t River Basin
Adj. Wtr. Body (nat /man /unkn)
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body—
d' A,.A.
Agent or h, plicant Printed Name
cl
Signature Please read compliance statement on back ofipermit
Application Fee(s) Check #
Permit Officer's Printed Name j
Signature ` f
Issuing Date s Expiration Date

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 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, 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 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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(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://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �!//
Mailing Address:
Phone Number:
Email Address: ZY / ! P S c`rn t�-y, �✓ G t
i certify that I have authorized e, e
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:Sf�''i/jam
at my property located at
in (.. dV"'1-"i'-e-County.
�/& oe��z �S, t4
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Penn * Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
10
/ Sig4y—pe�
nature
Name
0 W .'`? e f -----
Title
2- 113E f
Date
This certification is valid through 2 1 / 'J / / l
RECEIVED
FEB 15 2018
DCM- MHD CITY

14
I �
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to / ��.
property located at S�' �%��-C (Na��j of Property Owner} ,S
on IVOrMocivJjVq ��> f�-(Address, Lot, Block, Road, etc.
(Waterbody) in Z2 �`�•� 1�7,N C( iy/Town and/or Couy
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
6116iP4oual PropO5rng deve%pert£ B8?e` !!# in deSordp$sOn below OF affach +a Site t?fPa�,dPt
WAVER SECTION
c:I0
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boa
o Ouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. {lf you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner Information)
1�71'acent Pro Owner Information)
Signature
13:
PnnforTy eName J
,qr,e N"e
t U/agltng A dress ' ` �r�c4 ✓
e f Mailigg ddress�� /
Clty ta/Zi dY/5�felZtr (, 2 /�
Telephone Number/email address Telephone Number/email address
Date
— /3 -- % � ISM
Date*
*'Valid for one calendar year after signature* (Revised Aug. 2014)

EDE YAC
r c UB
Feet
information displayed by this website is prepared for the inventory of real property found within th�isdidioonn and is compiled from recorded deeds, plats, and otl
lic records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for verification
information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does not guarantee ti
data and map services will be available to users without interruption or error. Furthermore, Carteret County may modify or remove map services and access methods

ENT i� Rt NPR PAR l ER TBEM �"
! hereby certify that t own property adjacent to 7 /� %�---
a cox,
property located at �i ''�arrta of
;Q Owner) s
on'd�ddress, Lot 9io
in .Road, ac.}
(Waterbociy) �'7'rt�c N.C.
and/or County?
ocatio
The applicant has described to me, as shown below, the development proposed at t
ln
i have no ob_iectiort to this proposal. he above
------- I have objections to this proposal. �-- �' i� "� -4�`41
ESGfdI€�1O�i®ft�R tVG d = PROPOSE® i3EVELQPME�fT
iIrnd9F'�7I�f'P%;�€�tpx;fw` ��Z1�'rC3>idt�;� E iy3fa�<:4jd��
cs or3 bafow c�-attach a site &"Wj g�j
GJA
RECEIVED
FEB 15 2018
DCM- MHD CITY
WAIVER sECTION
l understand that a pier, dock, mooring Pilings. boat ramp, breakwater, boathouse
must be set back a minimum distance of 16 from my area Of riparian access unless wa vedr by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
--- ----� 1 do wish to waive the 15' setback requirement
1 do not wish u V aloe the 151 setback requirement.
°. -aZy - mittr inrormation)
zSzgnat
�- 7/ I�/4
Print or T�+vpe Name
. r1 Zr Y" -* r
12f
City/Siafe/Zi '� "
-- 7/ -- 4-1
Telephone Numb rlema# address
Date —
'Valid for one calendar year after signature}
(AcClacent Pr)perty Owner lnfOrmation)
Sign aiure--
Prins or Type Name
wiling Address
city/State/zip
Telephone Numberl email address
(Revised Aug. 2014;

PjPARIAN PROPERTY nwmco L-1&19MENT
hereb}ry that I own proPertY adjacent to f� /r/ d
,s
properly Iacatoq at Sf` Psi P Owner}
-—�_
tAddcessnRZMA�?f
The appticant has deSeribed to tile, as shown below, the development Proposed at the move
focatlon.
_ I have no objection to this prot)osai.
I have tihle %0f1s to this proposel.
DESCRIPTION ANWOR DRAWING OF PROPOSED D�IEL4Pmr:NT
sz16:iv;d`aw pgctpos r.m dyev0i0r5?mats: t!! in des- W-0i 13af3w ctr at;sactr i3 #e ` rarwl'n9i
A.L10 CHIN -INO(3
sm 91 83�
a3A1303b
A61VER $9aTtai�
i Understand that a pier, dock, meorir;g pilings, boat ramp, breaKwater, b-oatttouse, tft. or groin,.
must be set back a minftxttim distance tri 15' from rry .area of riparian access unless waived by
nee. 0f you wish to waive the setback, you must initial the appropriate blank 5eiow.)
do wish to waive the 15' setback requirement.
— I do not wish to .waive the 15' setback requirement.
\�l -(5t'O perty Owner lnform►ation) (Adjacent Property Owner Information)
1 t�s� c. l�-s►
;Szgtaa.�
'01111i er i , e Namff
G, �, iyp t��rrre
`i/t3tilr�y AcltlfeSs ,f Z �7 tr; isNno .4dIdness
�li e+f lbrj � . ! 3 r � L,•�-� � es:,._ `j� �'� _
crephore Aju S r: emaff add ss i e epimne Numbert wnelf addiess
a Duty*
=Revised Aug. 2014)
"Valid for one calendar year alter signature'

0780
G UB
ViWA
S t : 35 Feet
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 otl
ilic records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consulted for verification
information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Carteret County does not guarantee tl
data and map services will be available to users without interruption or error. Furthermore, Carteret County may modify or remove map services and access methods

b..CAMA / ❑ DREDGE & FILL }
70G939
PERMIT Previous permit# A B�/ °
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources C prrimissicon in In area of environ ental oncern pursuant to I SA:NCAC I j
i]Rulesattache .
i frole'ctLocame ation: County N
Address '' ` Stre
et Add ess/ State Road/ L t #(s)
City �` 1 i State ZIP/'i 1 �-
)
Phone # _Mail Subdivision A {,
Authorized Agent! { ..��,Q
Affected ❑ CW 9 `EW *A ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
cityl
Phone # (tt//
Adj. Wtr. Bodyll �-3(
Closest Maj. Wtr. Body
-.. • ... - :
III
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Agent or,*pr1cant Printed Name A;
Sigmto e * Please read compliance
Application Fee(s)
statement on back ermit **" Signature
heck # Issuing Ds
Date