77499_Pamlico Plantation HOA_20201214

.CAMA/ ❑DREDGE & FILL N° 77499 A C D
GENERAL PERMIT .7--D4(-°-1 `3 Previous permit# K1/A
>: KNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 11/A
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 5A NCAC 0 -4 - 7.../600 .
p 'l / 1E Rules attached.
Applicant Name 4n1L:Lo 17L) JTA' O K014 Ln1 arNA CvP itk))roject Location: County g E4U F cia
Address /SD C C t,t 61-I onS CTCIRC LE.- Street Address/State Road/Lot#(s) OF i -FT Ale_Lc°
City I/O ASN atATD1.1 State N G ZIP ,, .4.5S9 _;t.,A s"t h i L.o r jM 41,(2.-TN A
Phone# (-'SL) 941°-239 0 E-Mail Subdivision PAnh L-Lct- ?LAN T 41 I.C'. N
Authorized Agent <0,55 i e. I4 C O r11 S City 1,(,)R5k.1 t 3(.1 b N ZIP .-'3 S'Esig
Affected ❑CW ❑EW 525PTA ❑ES ❑PTS Phone# ( ) River Basin 7/4 R../]' v'i
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC s : Ad'I.Wtr. Body �g0RD R.E C �K.- na /man /unkn)
❑ PWS:
Closest Maj.Wtr. Body PAr�Ct co i J e r
ORW: yes /�`no PNA yes / no
Type of Project/Activity TN STA Lk, ....) fi 1 x ,3' f)14 ci ue1207 �bP i L 1 , IS
L-1 b `7 / V, -5 / -6 - 19 (Scale: )
Pier(dock)length
Fixed Platform(s) t j
Q
Floating Platform(s)
Finger pier(s) f* ' ! '
Groin length K
number ........... .._ ��!.. I I ....... ..._
Bulkhead/Riprap length 4\T'_ , ;...... t- .. _ ' _,
J
avg distance offshore — \ ! ----r-
, [i�
max distance offshore 4L ! Sj1C ( ‘of I I t
i
Basin,channel 1� g I �[�j:4 0 i
iJ�' I P �j
//t' ' 1!. .' ib `�ti ! 1 S)-'
cubic yards f � i ' L.Tt"1 4/1) �` j �\"p
Boat ramp ISA) l�.
i
Boathouse :•. ._...__ .. __.
; if i N -K,t..)ii,
I I ,,4ncvuefet� — I�► 1 !
Beach Bulldozing "' � t i j • 4....., L i_. /'�
Other • ■ I (, , I! 1 i� �� r I II ;
• a' ; i 'Pi..." • IS i •
•H • j� r 1 ai ; r.
t' ! { 11u-st[ioliA:
6
tire
Shoreline Length t //aoo _4_ ' • I F1;42 ' I ,
SAV: yes no ; -._ _ 6'$ 1"5 1 ._.. i &..I .
t l
I I I
Moratorium: n/a yes LBp r f ��;T 3=°5�.. �f5- � � E..�+
_._..�._ _-_ _ _,�l j_� ._
Photos: yes t(f) j _
Waiver Attached: yes no 1 ,
A building permit may be required by: feu IA'CO r k (C>L4 1,1V\ . X1 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) • \ / /
Notes/Special Conditions G0 r I$ U e\e'op P- W/ do)74o(,!Se Tc I !�G , T l-
ly1 a ►,,k-vo cA e c) I cA&v1 . �a r4 i L t- T s -1-:- ?� w ZIA I C,x1 s;�r--(.
FIN?TTR-...N i d T 14)ET 3LI?S .
<t0,_s sic, kkks— AAWA\ --tig,ict2_Volls). 11 \ 1 C,fo")‘y
Agent orrAppl_icant a Per�miittOfficer's Pri ed Name
Signature **Please read compliance statement on back of permit** Signature
1.1I Pb L0b.°= iyl91 /q— Dec - 2026 1'] - np,,�,) - ,2 ., k
Application Fee(s) Check# Issuing Date xpiration 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 I)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(9 I 0-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
40I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

.
41 CAMA / ❑DREDGE & FILL N° 77499 A ;'B r C D
GENERAL PERMIT ' '- Previous permit# . ',/,',
��-% KNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ;./11
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 7 N . 2.16.ct c, .
!' - Rules attached.
Applicant Name P�4W1tUCo 114oI*1' C)3 00.4 tlllA? ;`z+�t' Project Location: County ) C .
Address, tt✓S1) i...„' (..i..i'i Pic),--4 t LI RC LE Street Address/State Road/Lot#(s) G i k -i An)c i.i�,
City tIV A 41' a tJ&i 1 i 1J State C. ZIP ;215 Sc1 c +i `-i ; r l i ; c.. t`. }M NIN CZA.N A
Phone#(15 Z) 9114o- r39 C E-Mail Subdivision rof(....-Lc ?L✓)i'J 1 4 , ; -\
Authorized Agent A 6 ,t?' I-'i di rn 5 City WASP 1►J 1 b N ZIP )-?
Affected ❑CW ❑EW 21 PTA ❑ES ❑PTS Phone# ( ) River Basin /'i Z /P,d t YYi
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body g 0A i> LRt,..4.- 14" a /man /unkn)
Closest Maj.Wtr. Body '
n0 ORW: yes / PNA yes / no)
Type of Project/Activity iJ tj , is L.- 5 J t I 74., 13 t,);d t ki T2(1:7 ��;x)-) '. I.1-- i,s
_ 1.-_) - . " S 13,, 19 (Scale: )
Pier(dock)length
1
Fixed Platform(s)
Floating Platform(s) ___J 'g . _ i. , , ..___. . , , -°1 _ ,
, , , „
Finger pier(s) '
Groin length Z ,
tt
number a_........_._..._T_ ' __. ............. i
Bulkhead/Riprap length j „- 1— - _..�- ._._ _-._._..___ is ._
avg distance offshore , ' /�"
max distance offshore AIL 'Sr 1*I l I I I 1 I V U
lJ
Basin,channel `‘ " It ,i! .t
�` � Al `'
C3 _ t L
cubic yards t)r �� t y N��t.t!'Z Stiv 4 Iti 1, �''
Boat ramp c44
Boathousef Boatli (F) 4.:1 -- — _....._ _.
ems- ** - .._._ 1-. ........_e- I .. * — e i}
•
Beach Bulldozing _ 7 r+ R 1- • • r tT t
;ice. 11 I I 11 11 1! i t 1 1 �
Other .0' ' a
1 i Ti n: 1 ,
A ,
�1 , o I 4 ;; . r a i --
, k
, , ,
,s,,.., ,,,,_,„‘ , ,
A
, --
Shoreline Length f J,,• ,,„,,..„ _ , 1 r a + " .3
, 4
SAV: of sure yes no ' g'3 , - : I, ' I l 6-11 - -
,�. itis-it ►..1-(�— i _— �- 4A.t►.--r '
foa
Moratorium: n/a yes L.
Photos: yes ; ..... .. l -
Waiver Attached: yes f no)
A building permit may be required by: r-k COU w1 y . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) "� /
Notes/Special Conditions �.D t 1 f9 6 ev el op t'v �l L/tS7h4..-)W,Se - "f�144 , " L
ni G i,,.'f-41i,49 iGL600 • �3i✓71� t (. �1- A- S T...) I Z,a IA) IA/1 ?'ki t-" c
-S..\\II G i^ kit- 7 .5( L S .
s(4SSIC, c— AeY\ �1 , 115h\ey Cfo)'1 -
Agent or Ali Printed._Name.. ,__ Permit Officer's Pry ed Name
Signature Please read compliance statement on back of permit** Signature
r k PO s 206.`. I -, 1 q— Vet - "eZa — P-1 - >pf71 ,2a,2+
Application Fee(s) Check# 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 I)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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. I 27 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

These drawings are not to scale.
Piling placement showing new pilings Typical boat in lift. Note that no part of boat or
within existing pilings. motor extends beyond outer pilings.
• Existing Piling 0 New Piling
CI 0i di
ctd
i
f
I
1` #
Li 1
lip Cl.‘
t..:74 loi-- (\
i iii\\'
ATM.-:_-� ..� �.
1 1
411J ',,, I
t \
i„..........._ k !
d T i 't
1 ; j

f
Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Title: Boat Lift Application Date of Issue: 16 August 2017
•
Name -B(-}U J -1- Li,vDA kt.c Date /a -30 - 2-O
Address alb 7 LIVE CDA 1 I,iPvE Lot/TH c4.3
Telephone (H) a.s2-Cod 3-16`)- (C)77`f-2511_33'4'? oh) 77(1- 5 -3�83
Slip Number to be Modified d3 / 9 Slip Size /6 X 3 G
Boat Size (LOA x Beam) oZ-.S X $, 5 Hearn
Contractor Installing Boat Lift: 13 s ( 1-. JNt SEg ,c Phone Number:02- 94/3- f'(977
Electrician Installing Boat Lift: /hwft GR/P.(/IJ Phone Number: 2.522-4402 `i/UO
Requests for placement of boat lifts in the marina will be considered for permanent lifts requiring
additions or modifications to the marina infrastructure, i.e. pilings and electrical, and for floating
lifts that do not require modifications. Permanent boat lift requests will be considered for docks
B and the inside of A only, located next to existing lifts if at all possible., It is the applicant's
responsibility to obtain a slip assignment before submitting this request. The Marina Committee
will assist the applicant in obtaining a suitable slip assignment. Floating lifts that comply with
boat length requirements and require no permanent modifications are not restricted to Docks A
and B.
The following guidelines must be complied with in order to receive Board of Directors' approval:
1. The property owner, hereafter referred to as the applicant, seeking to place a boat lift in
their assigned slip shall submit all application documents, lift plans, manufacturing
brochures and pertinent information to the Marina Committee before approval will be
considered.
2. The applicant will obtain all required CAMA permits and furnish the Marina Committee
copies of the approved permits prior to any construction. The PPPOA will provide a letter
to the assignee of the slip stating that the assignee is appointed to act as the PPPOA's
agent in requesting the permit.
3. The applicant shall comply with all the rules and regulations of the marina, including the
submission of a Boat Identification Form and a current liability insurance declaration
page with this application.
4. Any boat on the installed lift should be totally within the slip so that no part of the boat or
its motor protrudes into the fairway.
5. If the boat lift must be removed to repair or replace the pilings, finger piers, or docks,
removal will be made in a timely manner at the expense of the boat lift owner.
Page 1 of 4

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Tlt e: Boat Lift Application Date of Issue: 16 August 2017
6. The applicant understands that the boat lift will not be insured by the marina and that
liability for damage caused by the lift or by the boat in the lift is the responsibility of the
lift owner.
7. The lift is the property of the slip assignee and is to be conveyed with all rights and
responsibilities to future owners. The lift can be transferred to (a) a new owner of the
lot/townhome, (b) another PPPOA member and the slip will be reassigned to that
member, or (c) someone else and the lift and its associated pilings must be removed
from the marina. If the slip assignee sells his lot/townhome and is no longer a member of
the PPPOA the disposition of the lift must be settled before the sale is completed. If
required, the responsibility for the cost of removal of the lift lies with the seller of the
property and must be carried out prior to conveyance of ownership.
For lifts requiring pilings and other permanent modification of marina infrastructure:
Refer to Directions and Specifications for Applying for a Boat Lift for piling and electrical details.
8. All new pilings must be consistent with the piling height of the marina pilings where
possible. Newly installed pilings must be inside the existing pilings of the slip. No existing
pilings can be cut or modified for any reason.
9. No piling placement is to take place unless a Marina Committee member is present. It is
the responsibility of the applicant to coordinate the work with the Marina Committee
representative who must be given a minimum of notice of 48 hours.
10. Electrical connections for the lift must be made by a licensed electrician according to
specifications provided by the Marina Committee. Electrical work is subject to inspection
and approval.
11. Adjacent slip assignees shall be notified of the proposed boat lift and given an
opportunity to either address the Marina Committee at the next committee meeting or
contact the committee chair if they have questions before the installation is approved.
Copies of the signed attached notification form shall be appended to the application.
The applicant must submit this request to the Marina Committee after ascertaining that the
applicant is able to meet all of the above requirements. The application will be considered by the
Marina Committee at its next regularly scheduled monthly meeting, and the applicant is
welcome to attend the meeting. If the application is approved by the Marina Committee it will be
forwarded to the PPPOA Board of Directors at its next monthly meeting for final approval.
If the Marina Committee does not approve this request, the applicant may appeal the decision to
the PPPOA Board at the next Board meeting.
Any questions concerning these requirements and this procedure should be addressed to the
chair of the Marina Committee.
Page 2 of 4

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Title: Boat Lift Application Date of Issue: 20 January 2016
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s)Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
Name of lift applicant g
Address ao- 1 �.v� � (aNt-
Telephone .1 q 3q9 Cell Phone 252 - 6 Z.3- yZ.
Slip to be modified V ,- I
Item 10 of the boat lift application requires the adjacent slip assignee(s)to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If you do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the second Monday of each month.
Adjacent slip number 15-1 I wish to comment: Yes No
Signature, adjacent slip assignee Date l ZeZ0
asa .-a\`63-t4 Page 3 of 3

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Title: Boat Lift Application Date of Issue: 16 August 2017
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s) Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
Name of lift applicant DA-V + L \
Address 026'7- rive- 0AI4._ rve
Telephone 774-a __
"33'1� LPhone] /
11-ornEJ
Slip to be modified g i1
Item 11 of the boat lift application requires the adjacent slip assignee(s) to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If yoq do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the first Thursday of each month.
Adjacent slip number IJ I wish to comment: Yes No
Signature, adjacent slip assignee ' �' Date I Z 2 Z4,�`.i
` 1,l\C.M.i\v\C`
Page 4 of 4

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
(Name of Property Owner)
property located at 150 Clubhouse Circle
(Address, Lot, Block, Road, etc,)
on Broad Creek , in Washington , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc�tipn�
I have no objection to this proposal.
I have objections to this proposal.
' w
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a site drawing)
The installation of boat lifts in existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA.
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop- Apir fo ation) (Adjacent Property Owner Information)
na Ce Signature
(Ark, l Go V la,r1 4' M Kassie Adams —Townhome Owners Association
Prin or T Name rihk ch ✓
I y(AV� IJSe-- C(rGL chat Print or Type Name
126 Forecastle Court
�(1a�hn ddresf$P�i�1 G �� Mailing Address
YV' '
Washington, NC 27889
City/State/Zi City/State/Zip
9,S 'g4Ce.a'35U 252-946-2390
Te IN)ge Nabrer Telephone Numaber
v
• �ac.))
Date Date
(Revised 6/18/2012)

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
(Name of Property Owner)
property located at 150 Clubhouse Circle
(Address, Lot, Block, Road, etc.)
on Broad Creek , in Washington , 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)
The installation of boat lifts in existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA,
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope w r In rmation) - (Adjacent Property OwnAr infn.mation)
GiAdViv4
tgnature lahWaf Iilport-S atgnature
Maws►4u(.6h Keith Gubbins
P ' t or Ty Name Print or Type Name
��d \U \j ) Q\v Cl./k 1117 Silver Oaks Court
cMailina Address G Mailing Address
rPK I\% I N3 L �1�� Raligh, NC 27614
ity/ t e tp c City/State/Zip
�' ��� 'a3 ��� 919-841-5671
Telephone Number Telephone Number
Ot-t . acsac, of{ b�QC G
Date Date
(Revised 6/18/2012)

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.8.4
Title: Boat Lift Application Date of Issue: 18 July 2019
Name/11/20/0/ 147' J/// 4% e Date
Address /llv F 19c 4 S 4-/ C+ Lot/TH //(O
Telephone (H) (C)32./-93 f-6 7 - gm_ 75S 6
Slip Number to be Modified B Slip Size
Boat Size (LOA x Beam) 3 V X 6
TBD A-5 le r o��'1 43-L I(o R
Contractor Installing Boat Lift: , J �� ��L� �.Q Phone Number:
Tt3D >4.sAp � •�c� Sf1O
Electrician Installing Boat Lift: ' et-5 � MP Phone Number: �
rt
Requests for placement of boat lifts in the marina will be considered for permanent lifts requiring
additions or modifications to the marina infrastructure, i.e. pilings and electrical, and for floating
lifts that do not require modifications. Permanent boat lift requests will be considered for docks
B and the inside of A only, located next to existing lifts if at all possible., It is the applicant's
responsibility to obtain a slip assignment before submitting this request. The Marina Committee
will assist the applicant in obtaining a suitable slip assignment. Floating lifts that comply with
boat length requirements and require no permanent modifications are not restricted to Docks A
and B.
The following guidelines must be complied with in order to receive Board of Directors' approval:
1. The property owner, hereafter referred to as the applicant, seeking to place a boat lift in
their assigned slip shall submit all application documents, lift plans, manufacturing
brochures and pertinent information to the Marina Committee before approval will be
considered.
2. The applicant will obtain all required CAMA permits and furnish the Marina Committee
copies of the approved permits prior to any construction. The PPPOA will provide a letter
to the assignee of the slip stating that the assignee is appointed to act as the PPPOA's
agent in requesting the permit.
3. The applicant shall comply with all the rules and regulations of the marina, including the
submission of a Boat Identification Form and a current liability insurance declaration
page with this application.
4. Any boat on the installed lift should be totally within the slip so that no part of the boat or
its motor protrudes into the fairway.
5. If the boat lift must be removed to repair or replace the pilings, finger piers, or docks,
removal will be made in a timely manner at the expense of the boat lift owner.
4 A314-S-P J.P e 4 't �Pcf/yd 7l2 rn"m ) Page 1 of 4
/2•i ev-.q Cd"D m ;

l' •

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.8.4
Title: Boat Lift Application Date of Issue: 18 July 2019
6. The applicant understands that the boat lift will not be insured by the marina and that
liability for damage caused by the lift or by the boat in the lift is the responsibility of the
lift owner.
7. The lift is the property of the slip assignee and is to be conveyed with all rights and
responsibilities to future owners. The lift can be transferred to (a) a new owner of the
lot/townhome, (b) another PPPOA member and the slip will be reassigned to that
member, or (c) someone else and the lift and its associated pilings must be removed
from the marina. If the slip assignee sells his lot/townhome and is no longer a member of
the PPPOA the disposition of the lift must be settled before the sale is completed. If
required, the responsibility for the cost of removal of the lift lies with the seller of the
property and must be carried out prior to conveyance of ownership.
For lifts requiring pilings and other permanent modification of marina infrastructure:
Refer to Directions and Specifications for Applying for a Boat Lift for piling and electrical details.
8. All new pilings must be consistent with the piling height of the marina pilings where
possible. Newly installed pilings must be inside the existing pilings of the slip. No existing
pilings can be cut or modified for any reason.
9. No piling placement is to take place unless a Marina Committee member is present. It is
the responsibility of the applicant to coordinate the work with the Marina Committee
representative who must be given a minimum of notice of 48 hours.
10. Electrical connections for the lift must be made by a licensed electrician according to
specifications provided by the Marina Committee. Electrical work is subject to inspection
and approval.
_11. Adjacent slip assignees shall be notified of the proposed boat lift and given an
opportunity to either address the Marina Committee at the next committee meeting or
contact the committee chair if they have questions before the installation is approved.
Copies of the signed attached notification form shall be appended to the application.
The applicant must submit this request to the Marina Committee after ascertaining that the
applicant is able to meet all of the above requirements. The application will be considered by the
Marina Committee at its next regularly scheduled monthly meeting, and the applicant is
welcome to attend the meeting. If the application is approved by the Marina Committee it will be
forwarded to the PPPOA Board of Directors at its next monthly meeting for final approval.
If the Marina Committee does not approve this request, the applicant may appeal the decision to
the PPPOA Board at the next Board meeting.
Any questions concerning these requirements and this procedure should be addressed to the
chair of the Marina Committee.
Page 2 of 4

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Title: Boat Lift Application Date of Issue: 20 January 2016
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s) Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
Name of lift applicant Harold & Kay Hilicher
Address 116 Forecastle Court Washington, NC 27889
Telephone [phone] Cell Phone
Slip to be modified B-05
Item 10 of the boat lift application requires the adjacent slip assignee(s) to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If you do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the second Monday of each month.
Adjacent slip number: B-03 I wish to comment: Yes No
TT�
Signature, adjacent slip assignee (/ �/ Date 00-d
C�FTdi Trust— Jim Mezzanotte

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.11.4
Title: Boat Lift Application Date of Issue: 20 January 2016
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s) Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
Name of lift applicant Harold & Kay Hillcher
Address 116 Forecastle Court Washington, NC 27889
Telephone [phone] Cell Phone
Slip to be modified B-05
Item 10 of the boat lift application requires the adjacent slip assignee(s) to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If you do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the second Monday of each month.
Adjacent slip number: B-07 I wish to comment: Yes No
Signature, adjacent slip assignee Date 0) 0 c 2e2,0
Ic \rVa. k

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
(Name of Property Owner)
property located at 150 Clubhouse Circle
(Address, Lot, Block, Road, etc,)
on Broad Creek , in Washington , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc5ion.. .
�7 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)
The installation of boat lifts in existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA,
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property er Info ation (Adjacent Property Owner Information)
naty re ` r Signature
itil, 1 GO �Iq(1,k'�-(o(./1 �i�- tettric{r�Gr,�ice, Kassie Adams —Townhome Owners Association
Pi in or Tyg, /Narrae Print or Type Name
CC�� pirv� Ore Le 126 Forecastle Court
ailin ddres Mailing Address
'" k c &' Washington, NC 27889
City/State/Zi City/State/Zip
' 14g a35 252-946-2390
Telephone Number Telephone Number
OU VCr dot Imo.
Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
(Name of Property Owner)
property located at 150 Clubhouse Circle
(Address, Lot, Block, Road, etc.)
on Broad Creek , in Washington N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
A 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)
The installation of boat lifts in existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA.
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 do wish to waive the 15' setback requirement.
XI do not wish to waive the 15' setback requirement.
(Prope ,l nor I orm ion) (Adjacent Property C wnAr i.+frrmation)
irti (4
,/d/t. E.-, atA/1/4 _
t natur• 3signature
).\V''O P\Q,A - POD- Keith Gubbins
PV' t or Ty Name Print or Type Name
CZ C Oh\Q.)'S.z. C\w cL� 1117 Silver Oaks Court
Mailing ddress Mailing Address
r MnS sin N3 C �18% 1)
IRaligh, NC 27614
City/State/Zip 1 � City/State/Zip
O� "CL`t� '(),3( 0 919-841-5671
Telephone Number Telephone Number
Ot( OeC ' cam) al-( Inc. .(1130
Date Date
(Revised 6/18/2012)

t
Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.8.4
Title: Boat Lift Application Date of Issue: 18 July 2019
Name C. A. M. Trust Date 11/26/20
Address 102 Riverview Drive Lot/TH 147
Telephone (H) (C) 704-651-1223 (W)
Slip Number to be Modified B-03 Slip Size 15' x 32'
Boat Size (LOA x Beam) 24" x 8'6"
Contractor Installing Boat Lift: T J's Marine Service Phone Number: 252-943-6677
Electrician Installing Boat Lift: Thomas Griffin Phone Number: 252-402-5110
Requests for placement of boat lifts in the marina will be considered for permanent lifts requiring
additions or modifications to the marina infrastructure, i.e. pilings and electrical, and for floating
lifts that do not require modifications. Permanent boat lift requests will be considered for docks
B and the inside of A only, located next to existing lifts if at all possible., It is the applicant's
responsibility to obtain a slip assignment before submitting this request. The Marina Committee
will assist the applicant in obtaining a suitable slip assignment. Floating lifts that comply with
boat length requirements and require no permanent modifications are not restricted to Docks A
and B.
The following guidelines must be complied with in order to receive Board of Directors' approval:
1. The property owner, hereafter referred to as the applicant, seeking to place a boat lift in
their assigned slip shall submit all application documents, lift plans, manufacturing
brochures and pertinent information to the Marina Committee before approval will be
considered.
2. The applicant will obtain all required CAMA permits and furnish the Marina Committee
copies of the approved permits prior to any construction. The PPPOA will provide a letter
to the assignee of the slip stating that the assignee is appointed to act as the PPPOA's
agent in requesting the permit.
9 q 9
3. The applicant shall comply with all the rules and regulations of the marina, including the
submission of a Boat Identification Form and a current liability insurance declaration
page with this application.
4. Any boat on the installed lift should be totally within the slip so that no part of the boat or
its motor protrudes into the fairway.
5. If the boat lift must be removed to repair or replace the pilings, finger piers, ordocks,
removal will be made in a timely manner at the expense of the boat lift owner.
Page 1 of 4

Pamlico Plantation Rules and Regulations Manual Procedure Number: R&R 30.8.4
Title: Boat Lift Application Date of Issue: 18 July 2019
6. The applicant understands that the boat lift will not be insured by the marina and that
liability for damage caused by the lift or by the boat in the lift isthe responsibility of the
lift owner.
7. The lift is the property of the slip assignee and is to be conveyed with all rights and
responsibilities to future owners. The lift can be transferred to (a) a new owner of the
lot/townhome, (b) another PPPOA member and the slip will be reassigned to that
member, or (c) someone else and the lift and its associated pilings must be removed
from the marina. If the slip assignee sells his lot/townhome and is no longer a member of
the PPPOA the disposition of the lift must be settled before the sale is completed. If
required, the responsibility for the cost of removal of the lift lies with the seller of the
property and must be carried out prior to conveyance of ownership.
For lifts requiring pilings and other permanent modification of marina infrastructure:
Refer to Directions and Specifications for Applying for a Boat Lift for piling and electrical details.
8. All new pilings must be consistent with the piling height of the marina pilings where
possible. Newly installed pilings must be inside the existing pilings of the slip. No existing
pilings can be cut or modified for any reason.
9. No piling placement is to take place unless a Marina Committee member is present. It is
the responsibility of the applicant to coordinate the work with the Marina Committee
representative who must be given a minimum of notice of 48 hours.
10. Electrical connections for the lift must be made by a licensed electrician according to
specifications provided by the Marina Committee. Electrical work is subject to inspection
and approval.
_11. Adjacent slip assignees shall be notified of the proposed boat lift and given an
opportunity to either address the Marina Committee at the next committee meeting or
contact the committee chair if they have questions before the installation is approved.
Copies of the signed attached notification form shall be appended to the application.
The applicant must submit this request to the Marina Committee after ascertaining that the
applicant is able to meet all of the above requirements. The application will be considered bythe
Marina Committee at its next regularly scheduled monthly meeting, and the applicant is
welcome to attend the meeting. If the application is approved by the Marina Committee it will be
forwarded to the PPPOA Board of Directors at its next monthly meeting for finalapproval.
If the Marina Committee does not approve this request, the applicant may appeal the decision to
the PPPOA Board at the next Board meeting.
Any questions concerning these requirements and this procedure should be addressed to the
chair of the Marina Committee.
Page 2 of 4

k
Pamlico Plantation Rules and Regulations Manual Procedure iftsher:R&R 30-8A
-ate: Boat Lift Application Date ofissue: 18 July 2019
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s)Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
Name of lift applicant C5 1� • f � � m AA()2 0164-
Address b 6Zi v C
Telephone lbq • 679. 1MCell Phone
Slip to be modified g"' 3
Item 11 of the boat lift application requires the adjacent slip assignee(s)to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If you do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the first Thursday of each month.
Adjacent slip number v I wish to comment:Yes No
in r S g atu e, adjacent slip assignee 71 1C-it Date b/2Z lZ 6
Print Name:yz_
Page 4 of 4

Pamlico Plantation Rules and Regulations Manual ! Pfixethire 88g8 30-8.4
me: Boat Lift Application Date of : 18 July 2019
PAMLICO PLANTATION PROPERTY OWNERS ASSOCIATION
Notification to Slip Assignee(s)Adjacent to Proposed Boat Lift
This form should be provided to the adjacent slip assignees and a signed copy of this form
should be submitted for each adjacent slip with the application to show notification has
occurred.
l
Name of lift applicant ` 11. ‘, 1\k• ��S 1 \i i vvv '
Address 9 oa
Telephone"1Ol 1951 'Cell Phone
Slip to be modified L
Item 11 of the boat lift application requires the adjacent slip assignee(s)to be notified of the
proposed boat lift, and given an opportunity, if desired, to address the Marina Committee at its
next committee meeting, or to contact the chair of the Marina Committee if he/she has any
questions or concerns before the installation is approved.
As the assignee of a slip adjacent to a slip in which a boat lift is being proposed, you have an
opportunity to address the Marina Committee should you have any concerns regarding the
proposed installation. If you have concerns or not, please so indicate by signing this form so the
applicant can return it to the committee. If you do have concerns and wish to address the
committee in person, please notify the committee chair. The committee normally meets in the
Clubhouse on the first Thursday of each month.
Adjacent slip number I wish to comment:Yes No
A' /X/11-V
19 br%/ 2° a °-Signature, adjacent slip assigneeDate
Print Name:_ ] -tt It dui/
Page 4 of 4

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
(Name of Property Owner)
property located at 150 Clubhouse Circle
(Address, Lot, Block, Road, etc,)
on Broad Creek , in Washington , N.C.
(Waterbody) (CIty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc tion.
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)
The installation of boat lifts In existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA,
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop: 4i✓�+1' : fo atfon) (Adjacent Property Owner Information)
na Ce Si nature
GO Plgn s�oln 004 Gty r g
Prin or Ty N e rin fit✓ Kassie Adams —Townhome Owners Association
��N , v LArG� Print or Type Name
a Im ddres 126 Forecastle Court
c �� Mailing Address
City/State2i Washington, NC 27889
�S 9�� a35U City/State/Zip
Telephone N mbar 252-946-2390
_ Telephone 2��.
Number
��/
Date lG` 1?e)
Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Pamlico Plantation Property Owners Associations
property located at 150 Clubhouse Circle (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on Broad Creek , In Washington
(Waterbody) (City/Town , N.C.
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)
The installation of boat lifts in existing wet slips on Dock A, Dock B and Dock C of the Marina
owned by Pamlico Plantation Property Owners Association (PPPOA) without any restriction as
to the number, the specific type or the manufacturer nufacturer of the boat lift as such boat slip lifts are
required, requested and needed, but subject to the approval of the Marina Committee and the
PPPOA Board of Directors, given in accordance with the covenants, By-Laws and rules of the
PPPOA,
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 do wish to waive the 15' setback requirement,
I do not wish to waive the 15' setback requirement,
(Prope w r In rmation) — (Adjacent Property Owncor infer
) f 6474/14
oration)
i na
lure l � tn lnOor�S 6•ignature
0 ACQ \QQN\C& PO's- etv 1-vA Ct `r Keith Gubbins
Pp or t Ty pp
Name Print or Type Name U�ONC)QS2 Q\v j 1117 Silver Oaks Court
7ing Address � ������ Mailing Address
•Ste ip Rallgh, NC 2761q
%� \'CNLP 'a3 i0 City/State/Zip
Telephone Number 919-841-5671
OL UG a e) Te/ephonel�Number
Date 6`� ^ C• c pj
Date
(Revised 6/18/2012)