Beaufort Marina Village Yacht Club 80415C

7CAMA / 13Rl DGE & FILL NO 804 i ti A B C D
GENERAL PERMIT -m` Prev ious permit #
Date previous permit issued
New Modification Complete Reissue _ Partial Reissue P
As authorized by the State of North Carolina, Department of Environmental Quality n �~
and the Coastal Resources Commission in an area of environmental concern pYr/S an tg 15A NCAC
I G' Rulesattache
,�
Applicant Name >„i �`�` _'� � �" t ('�' {RrOect Location: County 14_ ( — .--------
Address l___ _ _ _ Street Address/ tate Ro / Lot #(s)
city__ '' State �4 IP�S�(%
--- uvo
Phone #_ ?�), __LLL _Li( �-mail _ .. -Sbdiisi
— - �-„_--
Authorized Agent
— CW SEW TA
Affected - OEA HHF Ili
AEC(s):
PWyS�:
ORW: yes l n6 PNA yes 1
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
t, i
Floating Platform(s) r'�5 ' y _k,
Finger pier(s),-
Groin length
number - ---__—_--
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore —
Basin, channel
cubic yards _
Boat ramp _-
��a r
Boathouse atlift / t�
Beach Bulldozing
Other_,G _>/
Shoreline Len h _rno
SAV: not sure yesMoratorium: n,(a yesPhotos: yes
Waiver Attached: ye no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
1
ES 7 PTS
UBA "_ N/A
;nacu IN se read compliance statement o b ck of permit ,
n f
i ,
+nlir ion ee(s)
Ch #
City.—
Phone r�,dy
tA t
Closest Mai. Wtr. Body _-_,`
�IlfL ..r
i � � L•"� �r{J,�
r!. -
ZIP._' : -
I__ iver Basin <. _ ��t'7
(Scale: ! Y
`? r
14
_ See note on back regarding River Basin rules.
Permit Officer's Printed,- me
:yam'
ignaw;g r _
1 �r
L
Issuing Date
Expiratidn bate

❑ CAMA / [:]DREDGE & FILL `"V 80419 5 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 ao0
0
and the Coastal Resources Commission in. an area of environmental concern p g�/o
15A NCAC
o ❑ ules attachApplicant Name (' ect Location: County
Address Street Address/ tatq Road/ Lot # s
City rb9
i n State IP
, )) Phone # , _Mnil .. _ Subdivisiczn _
Authorized Agent
Affected
AEC(s):
ORW:
❑ CW
�W TA
❑ OEA
HF ❑ I
❑ PWS:
yes / ni
PNA yes /
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 atli t
Beach Bulldozing
Other (?V l/ V M%-%�
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes no
Photos: ye o _ _
Waiver Attached: ye0 no -
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions*
Printed
❑ ES ❑ PTS
❑ UBA ❑ N/A
City
Closest Maj. Wtr. Body
Permit
ZIP
Basin
(Scale: � )
❑ See note on back regarding River Basin rules.
Si at ire M**se read compliance statement o ck ofpermit rigna ur/ L
K p I i ch fion Fee(s) Check # Issuing Dat E)

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, certifythat 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 (252-946-648 I) 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/ 1-888ARCOAST
252-946-6481
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
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)
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:
f� CLLt t�
Mailing Address: r O% FOX ( 3
Phone Number:
Email Address:
zS.Z 7-1t 01710
r �ae t ( 11 &o e �mar l (�/vl
� v
i certify that I have authorized Lam— ` 132o ox--
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: r3 o4—r— t-tr—r— S L I P
at my property located at (e 5 P/ Vr.�S rse-A-n/i> PC> SEA )2T—
in C'/'�7�l��County. 2f'Sl
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:
Signature
ROD
Print or Type Name
Title
Date
This certification is valid through I y l�_/ 2y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F�� 1 ,
property located at
{Address, Lot, BI
on /�t'� in
(Waterbody)
r
of PropertygvKner)
(� - C L C !Il F . N C---
(C tOown and/or County)
I�el
The applicant has described to me, as shown below, the development proposed at the above
location.
C' 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, 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)
Slgl'1 C2/T'L'
Print or Tye Name
/PO'6O X ('5
Mailin ddress
6YZ���/G 28CP
City/State/Zip C O
Telephon Nu er/email address
4 zP 2-
Date
(Adjacent Prop rty Owner Information)
Signat
TU r\
Print or Type1 Name
Mailing Address
City/State/Zip
., 5-2 - 7z
Telephone Numbe /email, address
q 1/'�/-2--7
Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
� (N me of Property Qv�ner)
(Address, Lot, EI__..,
on s%t'' in
(Waterbody) (C
and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
v
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
r �r
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)
• "Sign tur e
Print or Type Name
roo 3o x '63 I
Mailin ddress
A/G
City/State/Zip O
Telephon Nu er/email address
2-e 2-
Date
(Adjacent Prop rty Owner Information)
Signat
-r;o %n 1;>v,N c-tl�
Print or Type Name
Mailing Address p IZ AJ
City/State2ip
TelephoneNumb /emailaddress
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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