Three Seas Legacy LLC

LAMA / ' DREDGE & FILL
,E]
NO ! 0409
A B C D
i_'
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 Costal Resources Commission in an area of environmental concern pursuant
to I SA NCAC
�
Rules attached.
Applicant Marne '' x.. : � ,
Project Location:
County
Address
Street Address/ State
Road/ Lot #(s)
City - State _ ZIP -.:
it .
Phone # () E-Mail _.
Subdivision
Authorized Agent
City -
- ZIP
❑ CW ::1 EW ❑ PTA O ES ❑ PTS
Phone # ( )
River Basin `w=
Affected
❑ OEA _I HHF ❑ IH I UBA ❑ N/A
Ad' Wtr. Bod
nat /man /unkn
❑ PWS:
Closest Maj. Wtr.
Body -- --
ORW: yes / no PNA yes / no
s
Agent or Applicant Printed Name j
Signature "Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Printed Name f '
� f
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 conclitionsf. 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
Mailing Address:
Phone Number:
Cam' /Cr7 /,-A / 4/6 - Oe5l
A25 Zj Z1e
Email Address: Cxa4 '/(
I certify that I have authorized / /inn nl; '
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Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed develo
at my rop//erty located at
in ro ,Ca County.
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I 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:
Signature ,
d
Print or Type Name
Title
l 7
Date
This certification is valid through / /.

=1►II0
I hereby certify that I own property adjacent to ► 1 s
4/) (Nan
property located at i � �r6kr l.�rret� R,
.'-� /Dp (Address,
�
on / roll C�reGx , in_
(Waterbody)
ER STA'
of Property Owner)
etc.)
(City/Town anfl/or County)
N.C.
The pplicant has described to me, as shown below, the development proposed at the above
locati
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)
:5" 4W. eL cC rmr w r r►
7
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)
nr7
iS * nature
f!Kit15 A ;�Jrr7c�S
n zPeM��
52
Date
email address
(Adjacent Property Owner Information)
t nature*
�,-,o
Print or type Narpq
artle ►'" CC/
M g Addres
City/State2ip
Telephone Number / email address
(f52)) G70--W3Co
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature'

CERTIFIED MAIL ° RETURN RECEIPT REQUESTED
DIVISION OF COASTAL, MANAGEMENT
ADJACENT RIPARIAN PROPERTY Y OWNER N071FICATION[9AIVER FORM
Name of Property Own
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter
I have no objections to this proposal. I have objections to this proposal.
If you have objections to ghat is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. N response is considered the same as no objection if you have been notified by Certified Mail
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.)
i I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
t"L y
Signature
Print or Type Name
Mailing Address
City/State/Zip
0 2. 04 c% —0
Telephone Number
5
Date
(A c nt Prope Owner Information)
Signature
Print or Type Name
�2 4-43 5�z'11
//Mailing Ad ress
City/State/Zip
,25'o2- i4,5- 3 % 3
Telephone Number
/11,4
Date
Revised 611812012