Bogue Sounds Yacht Club

❑ CAMA / �_', DREDGE & FILL No 71609
-.
GENERAL PERMIT Previous permit# A B C `D
LJ.New CModification LIComplete Reissue -'Partial Reissue y 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/concern pursuant to I SA NCAC
i ❑ Rules attached.
Applicant Name # �. Project Location: County_
1
Address t f -1 L � �' f Street Address/ State Road/ Lot #(s)
City P State :' ZIP_—
Phone # O E-Mail
Authorized Agent`
Affected ❑ CW qEW L PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes ,/ Bb PNA yes / no
Subdivision
City
ZIP
Phone # ( ) _ River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
ty t t
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 T
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
U
SAV: not sure yes no
Moratorium: n/a yes o
Photos: yes o�
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
r
,' (J /I 1 .
Agent or A plic nt Printed Name f
Signature **Please read comp ance statement on back of permit"
Application Fee(s) Check #
r
(Scale: )
f- r �j�i - ❑ See note on back regarding River Basin rules.
i
Permit Officer's Printed Name
Signature
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/ 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C- A-e ( e-S
Mailing Address: l 2 3 �j C C--k 'rA- ; S (Dc-.
fj(e4su.2+" �S.0L-1L L/
Phone Number: ?� ) 8� 2 L c�
Email Address: w r�-�( c�aryas � qZ� tS c ► C'
I certify that I have authorized ��� s — �Jcµ sw�4•-� �c<; f����� ,,�_
gen / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
69
at my property located at _ _ _�f lY JCam{..�IJ
in C� ��c r �'� County.
/ furthermore certify that / 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:
t
Signature
c, r Le (,/'- � )r a.
Print or Type Name
Title RECEIVED
l Date JUL �,Dl JUL 17 2018
ACM-WlHD CITY
This certification is valid through / /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to j b Lcv �C�rs1 ��
_ s
f Property Owner)
property located at -_( (Na"17l IL to
(Address, Lot, Block, Road, etc.)
on 61 �t� f —, in �� �. �, , N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown
ylocatio
� I have n b' f
below, the development proposed at the above
0 0 Jec ion 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)
0
r`
:p"5
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set,0ack a minimum distance of 15' from my area of riparian access unless waived by
me. (If you ish 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.
tr-rupeny owner inrormation)
Si re
cry Q 3� N
Pnni,or Type Name
Mailin Address
3sc- � r re-7 Q k a �►L
CinatelZ ��---
P
Telephon Nu be / em it ad ss
o �a - dI s %
Date fn
*V410 fb r on calendar year after signature*
(Adjacent Property Ow r Information)
Sign ure *
Print or Type Name
�.,O
Mailing Address
6ty/State/Zip
Telephone Number / email address
1 - q - Z- IQ'_,
Date
a5cF-N )
(Revised Aug. 2014)
3u- 11 2A
. ■un r:1T i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to>�����, L nI s
�
(Name of Property Owner)
property located at �u , / �/o
(Address, Lot, Block, Rold, etc.)
on 5��.., � , in -�7y , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
._S� I have no objection to this proposal.
I have objections to this proposal.
utscR'PT'ON 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.
trroperry uwner information)
-i . aatture
!>CZ I
Print or Type Name
clitvc) 7
City/State�lzip�
Telepne Number/ema' ddress
hLod{-
Date 72I n 1' V
(Adjacent Property Owner Information()
Signature
Print or Type Name
Mailing Tess C\ N C-
City/State2ip g 5 ` 1
Telephone Number/email address
gFrE1VED
Date*
5LP�Y
*Valid for one calendar year after signature`
(Rejl< &AAIi %4)
DCM_MHD CITY