TripleS Marina

CAMA / DREDGE &FILL l ley/ �-'�`�o. 73295
A B rC D
GENERAL PERMIT Previous permit #
❑New ❑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 mmission in an area of environmental concern pursuant to 15A NCAC Ru es attached.
Applicant N e �
{ '�. Project Location: County_' ---
Address:
Street Ad ess/ S to d/ pt # s
^ .r(r J
City f tatei V�_ ZIP
Phone # (_ L ail
Authorized Agerity'144
❑ CW EW PTA ❑ ES ❑ PTS
Affected AEC(s): ❑ OEA ❑ HHF 01A ❑ UBA ElN/A
❑ PWS: t11­�/
ORW: yes / no PNA yes / r{o
Type of Project/ Activity
Pier (dock) length _
Fixed Platform(s)
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 Bulldozi
Other
rty-t' � 1� j/�(`.. -, J ( 1 t ZIP_
Phone # (�;lY} U River Basin
y-.
Adj. Wtr. Body,
Closest Maj. Wtr. Body
(Scale:
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes
I
' I
Photos: yes
i
f
I
Waiver Attached: yes
A building permit may be required by:
❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
(
Notes/ Special ecial Conditions
�.
Agent or Applicant Printed Name
Permit Off' er
P n N e
Signature eadc mpliancesr
m tonackof
rmit
Si gna re/
Application Fee(s)
Check#
Issuing Date
Expirati n 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 howto 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)
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://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

In. H,vib�
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 'FIr2 d Bunn
Mailing Address: F0 zOX WID
Atlantic beat k , w' 2�5i 2
Phone Number:
Email Address:
I certify that I have authorized
Z52. 2Li-i. 4g3.S
gena 'Agi8' P email c 0 0
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: MH # $ 4
Yepc4%r ex1st'Ihc3 doLV--
at my property located at
1511 E. rT. Macon Rd.
in COr-V-erZ � County.
1 furthermore certify that 1 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 information related to this
permit application.
Property Owner Information:
a&A� =�
Signature
Gena Gml fh
Print or Type Name
Title
/ Ito / Za1g
Date
This certification is valid through / /

OTHER PERMITS MAY BE REQU-IR:ED, The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision .Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
S ATEMENT OF OWNERSHIP:
1, the dersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record title, 'Title is vested in name of
see Deed Book �-�j�} [ SS/ page _ J
in the -� _ County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of _-
; probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPEItTY OWNERS:
1 furthermore certify that the following persons are owners of properties adjoining this property. I afiin-n that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Blame) (Address)
(1) sirnon FOSS 402 take Pines Or. La Grange, NC 21?551
(2) RamH o
(3
(4)
ACKNOWLEDGEMENTS:
1, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and fioodproofing techniques.
l furthermore certify that I 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 information
related to this pennit application.
Landowner or
This the { to TH day of Ka , 201
.�tS.MV
authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this. farm), a site drawing as described on the back ref this application, the
ovvnership statement, they Ocean Hazard AEC Notice where necessary, a cher k for $100.00 made payable to the locality, and
any information as tnay be provided orally by the applicant. The details nl'the application as described by these sources are
incorporated without reference in arty permit which may he issited. Deviation from these details aril/ constitute a violation oj'
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative a n.
RECEI -
AUG 31 2018
nr.M-MHD CITY

CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Randy Hondrvs
Name of Adjacent Riparian Property Owner
12-1 1510nd Qvcty
Address
A.6, NC 2S512-
City, State Zip
To Whom It May Concern:
-20-I?
Date
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
rf. PC1% r e-Xi S-4-1 Y)Ci CIO% k
on my property at i 5 i i E. F fi. Ma Co n R el . M H ff 8 4
in C a Y t ct e 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: planner2(),atlanticbeach-nc.com.
Sincerely,
-ko/ --- &w
Property Owner's Name
2-5z- 7-L17 gF33
Telephone Number
�+ I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
4AM J1 4 " nA th 5- Zg - N
Adjacent pari ignature Date
qQnJ4 "UndYMS
Print or Type Name
( ,336) 97,,?- 6677
Telephone Number
IX-7 I Slur,d OLAaV Atlaofic BeacA A/c FTSi�
Address City State
AUG 31 2018
DCM-MHD CITY

CERTIFIED MAIL. RETURN RECEIPT REQUESTED or HAND DELIVERED
5• zo-Iq
Simon Co S S Date
Name of Adjacent Riparian Prope Owner
WA 'loge Pines give
Ad ess
a Gran yes NG a8551
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
ma Ke repairs fo cxlsfi n'ri clock
on my property at
IS-)) E. Ft. MAC,
in Ca r +-e re+ 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,
1,,d
Property Owner's Name
25z- zti7. ` Y'33
Telephone Number
,/ I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
'C-?� 5-2q-18
Adjacent Riparian Signature Date
1m0 n !ss
Print or Type Name
17D1 Ft, !Macon Rd
Address
g101) 5$o-�Sarc
Telephone Number
A f la n ti C &ea 6h A/C 2 8Si a
City State Zip
RECEIVED
AUG 31 2018
DCM-MHD CITY

CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED
Uatc
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
Date
Telephone Number
Address City State
Zip

M4*84
Locality Permit Number
Oecan Hazard l-,stuarine Shoreline ORW Shoreline -- Public "T'rust (Hier
(h'or official use only)
GENERAL INFORMATION
LAND OWNER - MAILING ADDRESS
Name r Trea bun n _.... ... ...._.. _...__. ___._ ____ __....._....__._____..
Address PO BD)( 1010
�j,, State a ' _27 zN 141
. yS3
City ��YI�+C WQ►u! . .�L� Zip_ `� I l hone
I y Q I g
AUTHORIZED AGENT
Name �im.A Son , �k
Address P Q 6b)( I_P.,.,1
City State Zip Phone
Email
G
LOCATION OF PROJECT: (Address, street Dame and/or directions to site; name of the adjacent waterbody.)
1511 �. GT Mgc-or P...d
6reCzJ St. MH IDt �g`f
DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance,)
SIZE OF LOT/:PARCEL: _ _ square feet . acres
PROPOSED USE: Residential [ (Single-family [] Multi -family [] ) Commereialllndustrial E] Other []
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Perurit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT" AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet (includes the area of the foundation of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are. within the applicable AFC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to tStateEIVED
Stornlwater Management Permit issued by the: NC Division of Energy, Mineral and Land Resources DE
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel:
sq"bfe%d 2018
DCM-MHD CITY

FILLING OUT THE APPLICATION FORM
The shaded area at the top of the first page is completed by the Local Permit Officer.
The LPO will assign a permit application number and check the AEC in which the
property is located.
In the general information section, the applicant and future permittee is always the
Land Owner, although an agent, such as a contractor or realtor, may obtain the
permit for the property owner. The applicant's mailing address is entered here. If an
agent is utilized to apply for the permit, their contact information is entered in the
Authorized Agent section. Location of Project is the address of property where
the work is to take place (the 911 address, subdivision and lot number, State or
County road, etc.). Description of Project should include all land clearing,
demolition, construction, and landscaping activities that are proposed to complete
the project. It is better to go over -board here, than to omit something that would
necessitate having to modify or re -apply for another permit to complete the
development. Size of Lot/Parcel can be listed as square feet or acres, or both.
Check the applicable Proposed Use, residential (single-family or multi -family),
commercial, or other. The Total Enclosed Floor Area of a Building in the Ocean
Hazard AEC section is only completed for those projects that are located in one or
more of the Ocean Erodible, High Hazard Flood, Inlet Hazard or Unvegetated Beach
AECs. Total Enclosed Floor Area is the combined square -footage of all of the floors,
plus any roof covered porches. If the project is not in the Ocean Hazard Area, then
insert N/A and go to the next section and determine in which Coastal Shoreline AEC
the project is located. The Size of Building Footprint and Other Impervious
Surfaces/Built-Upon Surfaces in the Coastal Shoreline AEC is calculated by
totaling all of the impervious surfaces within the applicable distance (30 ft., 75 ft. or
575 ft.) from Normal High Water (NHW) or Normal Water Level (NWL). Sometimes
the impervious surfaces that are allowed on an individual lot are further limited by
the conditions of the subdivision's State Stormwater Management Permit. The
applicant should insert the amount of impervious coverage that is allocated to their
lot under their subdivision's State Stormwater Permit. This number is usually found
on the property deed or subdivision covenants. Typically, any subdivision that was
developed after January 1,1988, will have a State Stormwater Plan.
On the second page of the application, the section entitled Statement of
Ownership is completed by the applicant using information from the property deed.
The applicant must check one of the three options and fill in the appropriate
information. Make sure that adjacent riparian property owners have been listed in
the Notification of Adjacent Property Owners section and that they have been
contacted by the applicant, either in person or by certified mail. Copies of the
completed letters and certified mail receipts, if required, should accompany the
application. Finally, the applicant/agent must sign and date the application at
the bottom of the page.

�a
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RECEIVED
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Z618