Ten Trees, LLC/Fred Bunn Triple S Marina 79642C

2
-.l AMA / ! !DREDGE &FILL ( V {1 7964A_ A B (C ; D
ENERAL PERMIT ----- Previous permit
ew Modification Complete Reissue ' Partial Reissue Date prev Vs per nit 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 NCA _
,le,attached
Applicant Nameej`��(o'd-Li , I I �L %�tij� n►(��S J' 1°rlec Loc�Go)County C
,,��
Address_ �- Street ddre s/ Statp Ro3 / (s)' nn
IC �- I �� '� l r G� 1 a
City •-� � � state ZIP
�- Q' _ _ C S
Phone # ^ r1L V -Mail Subdmo—
Authorized Agent:� City 5-v
ZIP _ _I 'iCW Yi ' TA ES IPTS Phone #)�r Basin b l/,Affected (�
AEC(s): I OEA I HHF ❑ Il UBA i I N/A Adj. Wtr. Body _ k`K/ / ian _ nkn)
I I PWS:
PNA yes ORW: yes / to / 0 1 Closest Maj. Wtr. Body t"o- (,. V
PN ---- I
Type of Project/ Activity
Pier (dock) length _ I-
Fixed Platform(s)
Floating Platform(s5Y(15-___
Finger piers) ��
Groin length '�---- !—_ --_
number
Bulkhead/ Riprap length
avg distance offshore •� '�
max distance offshow.,.-_ _
I _
Basin, channel
cubic
Boat ramp
Boathouse/ Boatlift
Beach Bulldozi
Other_"
Shoreline Lengtht
SAV: notsure yesMoratorium: n/a yesPhotos: yesWaiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
i4oent6ltiAobli tPr(nt�d ame t Peraiit%cerd�1a
i
I y�
(Scale:
a co pliance statement on back of permit Signat re
se
--- - _ — _ )Dive
8 ae p
i at Issuing ��x irat on Date
Fee(s) Check #

AMA / ❑ DREDGE & FILL 79642 A B i D
r. ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date prev' s per it issued
As authorized by the State of North Carolina, Department of Environmental Quality• , ,. �s��/�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCA
R/� ules attached
Applicant Name�r� QVi1_n ��ps I ' wect oc ion: County
Address Street ddre s/ Stat Ro / (s
CityW
te ZIP
Phone #� y Subdivi 'o
Authorized Agent City ZIP
Affected ❑ CW )TA ❑ ES ❑ PTS Phone #) % iv�r Basin _
❑ OEA ❑ HHF ❑ ❑ UBA ❑ N/A ^ e
AEC(s):
❑ PW .
ORW: yes / o PNA yes
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s yV,S
Finger pier(s) �--
Groin length =®
number
Bulkhead/ Riprap length *%-,
avg distance offshore -
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift�7 �
Beach Bulldozin-r-----'
Other
Shoreline Length
SAV: not s7yesn
-
Moratorium:
Photos: Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
e t n
or Apblicaht Printed f
Adj. Wtr. Body_
Closest Maj. Wtr. Body
Permit
(Scale:
❑ See note on back regarding River &sin rules.
c
Fee(s)
read compliance statement on back of permit
Check #
Issuing
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 complywith 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

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: F re CI Bunn
Mailing Address: PO Box IDID
(\i-jon-�1G B-eackr,, N(- Z `BIZ
Phone Number: Z e) Z) 2 L1 ' 4 'S 3 3
Email Address: t-r ► Pit S rV1 CA Y 1 n G 1 S 1 1 �_ � M fk ► I . C ( ►rYl
I certify that 1 have authorized Cy e n A m ► �� ,
Agent! Contractor
to act on my behalf, for the
purpose of applying for and obtaining
all CAMA permits
necessary for the following
proposed development: j c G k
kl u C K 5
i 0 01 A CA
at my property located at �6 S 1=t 3 `1
in —Coy- i it re t County.
I furthermore certify that I 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:
�A q t.�tA Signature
Print or Type Name
Mir
Title
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cost Fc i`t Marc,' Rrl I. !, `- Is
(Name of Property Owner)
property located at 611 Guest FUrt M"Ce"n Rc,t
on (Address, Lot, Block, Road, etc.)
�,.sr,t) in l F> t.�c�1� �Cc+rl-cre N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati�n.
I have no objection to this proposal.
I have objections to this proposal.
utat;rur i IUN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
I WA
understand that a pier, dock, moorin1VER SECTION
must be set back a minimum distance of 15' from my area of riparian access unl
g pi ings, boat ramp, breakwater, boathouse, lift or groin
me. (If You wish to waive the setback, you must initial the appropriate blank below.
ess waived by
I do wish to waive the 15' setback requirement. )
---___ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si a �rre
Print or T Pe Name
Maibn A dress
'E i2-
City/State ip
Telephone Number/emailaddress
D�lj��i
ate
iP)c Sfy)arI (),a Mal . CUPA
*Valid for one calendar year after signature*
(Adjacent Property Owner —in ------- —
formation)
�gnature
Pt, 5
Print or Type Name
banes Or. La (f�tll�t' 6iJ� Mailing Address
City/State/Zip
�-" ��
Telephone Number/email address
Date
(Revised Aug. 2014)
2sssf
L�51 Z

4

AD.DACENT RIPARIAN PROPERTY OWNER STATEM NT
I hereby certify that I own property adjacent to 17)�9
_ (Name of Property Owner)
property located at ��� i ,`" li A'p )F!>;
(Address, Lot, Block, Road, etc.)
r in i rr 7i`% .Lz
on
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
%. 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)
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.)
J I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
pity/State2ip
Telephone Number/email address
Valid for one calendar year after signature*
Owner Information)
Print or Type Name
Mailing Address
Telephone Numbed email address
0 i
Date*
(Revised Aug. 201

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