Wayfarer Cove Marina Co. Tom McCary

❑CAMA / ❑ DREDGE & FILL NQ 70412 A B C D
-� GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality i
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
..::' -.
• - a Rules attached
Applicant Name " (�Merl)
Project Location: County
Address/ Street
SAdds/ State Road/ Lot #(s)
Address �.�--,-
� terr
City State ZIP /1 7 f`
Phone # ( ) E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
ElOEA ❑ HHF ElIH ❑ UBA ElN/A
AEC(s):
❑ PWS:
ORW: ves / no PNA yes / no
Subdivision
City
Phone # ( )
ZIP
River Basin
Adj. Wtr. Body (nat /man /unk_n)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name % 7
Signature A* Please read compliance statement on back of ermit
ell
AtpplicationFee(s) ti Check##
Permit Officer's Printed Nark
Signat/ure�
i
Issuing Date 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 comply with 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
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)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: I0
Phone Number:
Email Address:
W"-�V(?VsCax Wairoj
�cnr)6'�+ �'d.
H
I certify that I have authorized�5Sc07f" Mar(r)C, Q)ryfru&/nn
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:A60k+2(( -4
at my property located at Ito-]
h n�
in County.
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 infonnation related to this
permit application.
Prop71�
ner Information:
C�
_ Signat
Ga2t-,
Print or Type Name
GA
uu Title
Date
This certification is valid through /0� l9 j l 6

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(� 1
I hereby certify that 1 own property adj3jacent to
(Name of Property Owner)
_4
property located at C C
(Address, Lot, Block, Road.,�etc.)
on rc�n �� NWI RSV , in i110r)�}'AVn1l(0
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locqtiw-
9::�
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing dev4cpment must flit in description below or attach a site drawing)
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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State-Op
Telephone Number email address
Date
'Valid for one calendar year after signature"
jacent Property Owner Information)
Si
F�riat or T, Name
ype
046V daK
telTp G� ZSZ Z 4s 0 d 13 ADM t4 �-p,t ud„)Q(c3Z?
T irong,�ber/ address
A// Go(r-.
Date;
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
Cnr)C
� Vv
v A-z l�l s
(Name of Property Owner)
L (Address, Lot, Block, Road etc.)
on I i} o) Ct-, 1 �Ui�� 1� , in M01ROM-1 �lr� �' N.C.
(Waterbody) (City own and/or County)
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
(Individual proposing development must fill in description below or attach a site drawing)
x S . ce a+1acVM JVaw ir.�{�
_J
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 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date
`Valid for one calendar year after signature*
(Adjacent (Pro'-pe-rty Owner Information)
�ttXJ-�� ` T`t-
Signaturelt N-T T
Print or Type Name
Mail�g
City/11Sttate/Zi
a
Tele hone Number/email address
Date*
(Revised Aug. 2014)