Triple S. Marina

N
❑CAMA / ❑ DREDGE & FILL N2 70499 A B C D
GENERAL PERM M 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 r "
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name
Address i
It
City
f. State ZIP
Phone #
e L' ;Mail
Authorized Agent
;
❑ CW
EW PTA ❑ ES ❑ PTS
Affected
ElOEA
ElHHF ❑ IH ❑ UBA ElN/A
AEC(s):
❑ PWS:
ORW: yes / no
PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
i
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
r
Shoreline Length
SAV: not sure yes ! .no
Moratorium: n/a yes fio
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction) ti
Notes/ Special Conditions
'-
'7
1
Agent or Applicant Printed Name
Signature Please, read compliance statement on back of permit
Application Fee(s)
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O r —1. River Basin
Adj. Wtr. Body `?' ` ` = ` (nat /man /unkn)
Closest Maj. Wtr. Body
J, f
(Scale: fit} )
❑ See note on back regarding River Basin rules.
PermitOfficer's Printed Name
Signature
Check # Issuing Date
P
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
Neuse River Basin Buffer Rules
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/ 1-888ARCOAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rQ a U
property located at
151% E. FT. Masi
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on beque S��.V►�L) in AHa►1 1 c bca(A-) , N.C.
(Waterbody) (City/Town and/or County)
s
The applicant has described to me, as shown below, the development proposed at the above
locat7.
1 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)
E xist-111%9
S1:p
de } 2
�t x 30
WAIVER SECTION
Bog L; f
Sound
T
V1
FT. MACoN 9-1).
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathousot fte
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.)0 3 1 NIB
do wish to waive the 15' setback requirement. MAY
I do not wish to waive the 15' setback requirement.
DCM_MHD CITY
(Pr erty Owner rmation) (Adjacent Property Owner Information)
&VVY,y
Signat Sig tune
Print or Type N me (�j Print or Type Name
la-1 Island Quaw Pt) 13QJ' Ivic
Mailing Address Mailin Address
A�VICAniiC i'C1Gi1, IBC; rl"12 p���nrIC beach. rJC 5i
Cityy/State1z' City/State/Zip
t33t.:S q�-(�(c`11 I.l 1333 % �Cnd4gl�� g11'►Cilii.�bY1�
Telephone Number/email address Telephone Number/email address
5_31-1 5-31-li
Date Dale *
(Revised Aug. 2014)
"Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F re U b U n n S 's
ame of Property Owner)
property located at 5 V T. M R u n
(Address, Lot Block, Road, etc.)
on gc6ld� 50UND -,in_ t TLFiNaIL WC14 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat V.
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)
�~4 J
v
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse,
must be set back a minimum distance of 15' from my area of riparian access unles iveM
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
AIM 312018
I do not wish to waive the 15' setback requirement. DCM-MHD CITY
FT , Macon
IZ0AD
(Property Owner Information) (Adjacent Property Owner Information)
a� -- r�
Si nature Signature
, i M6 A Foss Fred 96un
Print or Type Name Print or Type Name
40a Lake Pine (fit+vic PD kM
Mailing Address MailingAddress
LoL Groalae, NL -xss 1 Kta�+;c ��dC(' NC 1151z
City/StaT/Zip City/State/Zip
(9158b b� 4� Sfossnl,ve.cc 2N1-LIB-s gCAilLA I j► cowl
Telephone Number/email address Telephone Number/email address
5- 3i-IS' 6--'4 C?
Date Date *
(Revised Aug. 2014)
"Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT n
I hereby certify that I own property adjacent to R- AIZr/v j s
property located at
on A 0 A &-!Z
(WE
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)
a�
i 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
rr cl Bunn
Prim or Type Name
i'0 Box
Mailing Address, an-3; C Q�ac�, NC a3512
City/State/Zip
25z_ zti?.'4833
Telephone Number/email address
Date
*Valid for one calendar year after signature*
nt Property CWher I
PTA
TelepYlone�N�,u— email a�ir s�
Dale*
(Revised Aug. 2014)
2�'SiZ

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /L t %� /e - s 12960/%t/ zi 's
(Name of Property Owner
property located at /Ff —/�)Ac,0,J & �3 / -_joLAivJIL Ash >lir 2&$JZ
(Address, Lot, Blggck, Road, etc.)
on 009 U r- SOU n d in A ZA,,;1 ►e-- 1,,2,e � T_ N.C.
(Waterbody) (City/Town 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)
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.
(PY11w,
ertyOwner Information)
"
Sig tune
Fred Bunn
Print or Type Name
Mailin Address
Atha n-hc Bea (h A, 678511A
City/State/Zip
A5i. o1LfTq?33
Telephone Number/email address
5--icy-ig
Date
Valid for one calendar year after signature"
(Adjacent Property Owner Information)
Signature
Randy Hondrys
Print or Type lVame
)A7 151and QUccU
MaiAY10nhl C Beach, NC A851Q
City/a/�ip a ,4 -7. y s 3 3
Telephone Number/email address
5-19-1�
Date
(Revised Aug. 2014)

CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
R a n dq Hondlr v s
Name of Adjacent Riparian Property Owner
1 Z1 Island Quay
Address
Atlan� c Beach, NC 2Q512
City, State Lip
To Whom It May Concern:
5-I?_18
Date
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
�ns�-a11 a safe Navw -door+; na docX I a pdi nqs
on my property at I r i p l f S (V\a r l n a V 1 1I A. q e
in Car trwe+ County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
Michelle Shreve, Local Permit Officer, Town of Atlantic Beach, PO Box 1.0, Atlantic Beach, NC 28512
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact Michelle Shreve at 252-726-4456 or by email at: [e-mail].
Sincerely,
operty Owner's Name
25Z. 291. 4 U 3
Telephone Number
JI have no objection to the project described in this core— "-)ndence.
I have objection(s) to the project described in tiv dence.
.ZJM 404244�
Iacent Riparian Signature
Runcly Hondrys
Print or Type Name
2-1 1SIund CuCX
Address
5-1q-1
Date
(33(,,) 9-12- 6(6-77
Telephone Number
}IaniiC beach NC awz
City State Lip

CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED
I)atc
Name of Adjacent Riparian Property Owner
Address
City, State Zip
To Whom It May Concern:
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
on my property at
in
County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
Michelle Shreve, Local Permit Officer, Town of Atlantic Beach, PO Box 10, Atlantic Beach, NC 28512
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact Michelle Shreve at 252-726-4456 or by email at: [e-mail].
Sincerely,
Property Owner's Name
Telephone Number
I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Adjacent Riparian Signature
Print or Type Name
Address
Date
Telephone Number
City State Zip

+ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: F YeCI Bunn
i
Mailing Address: PO k& 1010
fltlarntic Beach . Nc; a5i�
Phone Number: a5 3, Li 1 3 -3
Email Address: q CY164 4 w I g Q) g MCA C U M
I certify that I have authorized Geyla Sm � ifh ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 6 5 # 3 is Saf�c hayft')
fl0a� n5 doc�- ins -61tt
Z- a; % ( nys
at my property located at ► 5 i i E • F i. M aco n IZd
in C-ar tf V'f_County.
I furthermore certify that I am authorized to grant, and do in fact grant permission
Division of Coastal Management staff, the Local Permit Officer and their ag(
on the aforementioned lands in connection with evaluating information re
permit application.
Property Owner Information:
Signature
Ge,na SMi +h
Print or Type Name
. TG M\/
Title
Date
This certification is valid through
to