Camp Vandemere Inc. C/o Victor Jones

❑CAMA / El DREDGE & FILL
N2 ! 328
GENERAL PERMIT
A
Previous permit#
B C �D
❑New ❑Modification ❑Complete Reissue El 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 environmen al concgrn pursuant to I SA NCAC
1 r {
ules attached.
Applicant Name Project Location:
County
Address I Street Address/ State Road/ Lot #(s) !)
City , i `,r State CZIP
Phone # O E-Mail Subdivision
Authorized Agent City
ZIP
❑ Cw G EW ❑ PTA .. ❑ ES b PT5 Phone # ( )
River Basin
Affected ❑ OEA ElHHF C IH ❑ USA El N/A
AEC(s): Adj. Wtr. Body
' t .' "
:f:>'� t nat man un n
Closest Maj. Wtr.
Body
ORW: yes / no PNA yes / no
Type of Project/ Activity
(Scale:
Pier (dock) length
Fixed Platform(s) -OF- -
Floating Platform(s)
Finger pier(s)
_ i t
Groin length
number-
i
Bulkhead/ Riprap length /
avg distance offshore r
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes 6nL—,
I ! '
Moratorium: n/a yes f
Photos: yes t + _w. * _
j -
Waiver Attached: yes
I� C
A building permit may be required by: e ' ' f " { ' ;M L1�J See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) f
Notes/ Special Conditions
Agent pli Pi ed N e
Signature ** Please read rotnpliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Printed Name
Issuing 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 (252-946-648 I) 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 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)
http://portal.ncdenr.org/web/cm/dcm-home
(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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to fizt'4P u4zd d E-4A 5(�� /-/(-- 's
_ �� (Dame of Property Owner)
property located at A) / h if Sf -
(Address, Lot)3lock, 5oad, etc.)
on ShF in ly A-'t,-,f4 . A/1 Ice N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc7, I have no objection to this proposal.
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)
CAAJoe
'J",) 1 1206.1
Iv,
->e�-� --- — S
I( WAIVER SECTION <�-+�,�' �
r 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sature
-to 1
Print or Type Name
-2 i
MAW Address
�,1/�//X F�'t-cam IVC 2 $5-27
City/State/Zip
� s-L-• ("?0 -g 7-1s
Teleohone Number
Date
Z%K27
tio -,
�
Signature
/3tclsoLL F►i ii. f}UUS's
Print or Type Name. ATTQZAJ6y-1A1 t "'
� 22 L
Mailing Address
3}�t�rc�2u n)C- 2 �515
City/�ate/Zip
2-L-=,2--7��s�l�
Tele h ne Nu ber
Dat
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I h(reby certify that I own property adjacent to
, ( ame of Property Owner)
property located at �=� i<_ ��_ � 1� `.
(Address, Lot,lock, oad, etc.)
on. / RJ..1/_f' - -- in _� _� l�T & (r�� N.C.
(Waterbody) (City/Town and/or County)
[he 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)
�ArUo�
Nil
r t 5t o'P5- ---�. �Q F
l _ 4
I WAIVER SECTION t� f4 w
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.)
Y I do wish to waive the 15' setback requirement,
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si rut►rr e J
Print or Type Me"'U
its /sf,
Mp rnc� Addr ss
l �Iri11l��t-eje e Ale;Z K5 2 7
City State/Zip c�
S Z . 1 y
Tele h re Nur ber
Date
(Adjacent Property Owner Information)
Signature
Pn��t or Typ /Vame
Maili g Ad0ress
rA�6
,
City/St terlZip(
Telephone Mimber
11 'l ''L�
_
Date
(Revised 611812012)