Cape Point HOA

7
D CAMA / ❑ DREDGE & FILL No 71655
--. A B C 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 Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name
Address
City
State ZIP
Phone # (_) !E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA HHF ❑ IH
❑ PWS:
ORW: yes / no PNA yes / no
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 Bulldozing_
Other
Shoreline Length ,I )/
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
❑ ES ❑ PTS
❑ U BA ❑ N/A
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP '<
Phone # River Basin` ` P`
Adj. Wtr. Body _ mat /man /unkn�
Closest Maj. Wtr. Body
(Scale:! �' )
[, 1✓� t 0 See note on back regarding River Basin rules.
}
Agent or Applicant Printed Nam
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
tOffiEer's Friated Name
Signature
ti
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT n
I hereby certify that I own property adjacent to V*�crsN f /%J��c��^�us i7.4 °C _'s
(Name of Property Owner)
property located at
3,
n (Address, Lot, Block Road, efc.)
on �CtrL. t"/t�t�� in i�i� !nil�.�"J �d•, N.C.
(Waterbody) (City/Town and/or County)
The appli ant has described to me, as shown below, the development proposed at the above
locatio .
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)
�qwcl 1610aa
DECEIVED
SEP 10 2018
DCM-MHD CITY
WAIVER SECTION
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 aive 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.
(Propert Owner I rmat. n)
Por
ure 1 400 a^ V441
Type Name
Pa 'AC IS"
M�+ling Address
l.utbeao (V(
aryistarl"`o) 33'0 .2?570
Telephone Nu9ber
43'/t'oh rrl
Date
(Adja e2;'�ey Oner Information)
Signat
• A gd6e �.
Print or Type Name \ �'
/gvJ, LJ
Mdi'ling Adcjress
(S o iv / /-C z7 d ez C
City/State/Zip
(�► ti l 1 8'- S6o �—
Telephone Numb r
9 /10 �
Date
(Revised 611812012)
3oo C,Yt A

I hereby certify that I own property adjacent to f ADc ...* NArJ:f, 0kWA.;(-c S /`rU0f. 's
�— (Name of Propert Owner)
property located at s • 37 e
(Address, Lot, 13lock, ad3 a C.
on _c2 �R ft�l( , in f�.sA. .1.r,1�e.�c N.C.
(Waterbody) (City/Town an orCounty)
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, 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propert Owner Inf math n) (Adjacent Property Owner Information)
K
S' nature S' ature
0-0 t // AS14'. A
Print �'(J t Name S Print or Type Name �� J
�✓u g g W 1-
MallinaAddres Mail' g Address
('4AZ Al
City Ci /s ate/Zi
/U 33v 2?So ?7�' R2. ECEIVED
Telephone Nu ber Tele hone umb
! �ihg 6V 9 a 71 L
Date Date SEP 10 2018
(Revised 6/65
W IN H D CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: r/aC at,v� •�►f a �,, ae s /�%sscr_
Mailing Address: & 1ih QS—
ev
Phone Number: Cq ( ()) ` 3 30 - 2 2S0
Email Address: /Ui 54,9,v . log. // I e YA4v* . C'j
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �9// lU.C1yd
��` I` �s Sly/ �3�% /9� l �5I�0 t /d ��- �/�"/ l!�?! �✓ /1
at my property located at S3 Zt %• a 1.v A ,
in &1County.
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:
O
Signature
t5 rw :�! Pecs. (tilt �
Print or Type Nam
Ax e ->j ie.�
Title
6 /Da/�
I �Ofj
RECENED
This certification is valid through 111 / S1 1 g SEP 10 ZWB
®CM_MHD CITY

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