Crows Nest Yacht Club Inc 78378C

CAMA / ❑ DREDGE & FILL 1V ']j'% A B (� D
�. ENERAL 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 n 000
and the Coastal Re rces Commissi n in an area f nviron en al concern pursuant to 15A NCAC /
Rules ached.
Applicant
(Name
, �7 / Project Location: County
Address `4f-t�f D� t): / % ,Yi(14 �Wreet Py�lress/ State Road/ 4ot #(s) A
..��.� G;-� �;! - • ��'{.'y;//7I�11r7L11�IZ�Irli
-- ,
Authoriz d Agent city
Affected
■ OEA ■ HFri ■ UBA ■ El •
.. .�iClosest Maj. Wtr. Bod
Pier (dock) length
Fixed Platform(s)
Floating Platform(sj-'
Finger pier(g) —�
Groin length
number
Bulkhead/ Riprap length
avg distance offshore ---
max distance offshore_
Basin, channel----- -�
a
cubic yards'--''
Boat ramp
Boathouse oatlift
Beach Bullddoozin
Other 1 / . Ul MYWIt
Shoreline Length v
SAV: not sure yes no -
Moratorium: n/a yes o
...............
Photos: yes no
Waiver Attached: yes o I ----
A building permit may be required by:
( Note Local Planning jurisdiction)
See -note on
River Basin rules.
Si kre I e read compliance statement on back of permit
)fil) Z� M, D2t;z,
ication Fee(s)
S
# I 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 [)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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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:
Email Address:
� - ��trtor1
I certify that I have authorized �'� k vJ�� Agent/
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at ya G -;&CA"r ,
in County.
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:
Sign ture
Print or Type Name RECEIVED
rn 01--� DEC 0 9 2020
Title
_1 1 1 � DCM-MHD CITY
Date
This certification is valid through / 1

ho-
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P tYy

Pr I)� m
-rifaE7 `SC i roy-1 s

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adjacent to C- {C�hJS `''
I hereby certify that I own property (Name of grope ty Owner)
property located ate (Address, L.ot, Block, Road, etc.) ��. N,C. .
,,��—'--'-= c—`A �fl `"" , in
on (C(Town an /or Count
r ` (Waterbody)
The applicant has described to me, as shown below, the development proposed at the above
{ovation.
l have no objection to this Proposal-
-
ESCRIPTION AND/OR DRAWING OF PROPObelow of DEVELOPMENT
attacha site drawing)
". 4 fill in description
(Individual pr,
1 )-4 54-IF -tom ) g
WAIVER SECTION `o� coin must be sat
rnoodng pilings, breakwater boathouse, lift, rJ
- i understand that a pier, dock, area of riparian access unless waive
d by me. (If you
back a minimum distance oou5mtus nitial the appropriate blank below.)
wish to waive the setback, y
I do wish to waive the
15' setback requirement.
I do not wish to waive the
(property Owner fo mation)
.o atzcre
Print or Type Name
15' setback requirement.
Maifing Address
it / to e/Zip
Telephone Number -- --_ _
Date
(Adja roperty Ownez Information
o ature
4��---
Print or Type Marne
,Mailing Address
City/statelzip
Telephone Number
DIV
(:Revised 6/13/2012)

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�' �� Owner)
I hereby certify that I own property adjacent to (Name R Prope ty�A
property located at LL
(Address, Lot, Block, Road, etc.) N.C. .
on �►-� 'mom —t�fl �n WlAt(Gown an /or Count
(Waterbody) osed at the above -
The
applicant has described to me, as shown below, the development Prop
loc ti�. proposal.
—
I have no objection to this pro p
D DEVELOPMENT
DESCRIPTION ANDIOR DRAWING OF PROPOSE
n below or attach a site drawing)
(Individual proposing development musf fiii in descriptiolob
r--`- V q r or
/ /`a 5t-)F `t- 1 g'
WAIVER SECTION. — _ roin must be set
ilin s, breakwater, boathouse, lift or 9 [Tie. If you
understand that a pier, dock, mooring p g
inimum distance of 15' from my area of riparian access unless waived by
back a �� ou must initial the appropriate blank below.)
,nrisl� to waive the setback, y
_ I do wish to waive the 15- setback requirement.
� / I do not wish to waive the 15, setback requirement-
----a®�D e Oyvnef information)
- � d' cent ropYl
(property owner fo oration)
.a Crtt£i"E
Print or Type Name
Mailing Address
.it / to e/Zip
`relehone Number
P
Date .____---.--
Sio All
'J
Tefe hone . umber Date j
l��avised 6/18/g0! 2)

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