Brooks Creek Marina Assoc. 79565C

CAMA / ❑DREDGE &FILL 9 79565 A B �,' D
N ERAL PERMIT Previous permit #
L�
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As thorized by the State of North Carolina, Department of Environmental Quality96(&
and the Coastal Resource Commission in an area of environmental concern pursuant to 15A NCAC
Ce
❑ les attached.
Applicant Name ✓�iJD 6(-rZ" , ��Project Location: County j' ✓�
Address
City t
Phone # 10
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS
State_ ZIP ,c W3—
A ❑ ES ElPTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes / Rio Z 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/ oatlif ` -,
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
Street Address/ State Road/ Lot #(s)
Subdivision r 1 Yz C Cr �3'
City ✓ �"�/ ZIP
Phone # ( ) Rir Basin
Adj. Wtr. Body at an /unkn)
Closest Maj. Wtr. Body U U�
(Scale: )
A building permit may be required by: "� ❑ See note on back r garding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
�( Agent or Applicant Printed Name
V"
Signfe read compliance statement on back permit
Ap ationFee(s) ( Check#
Signature
Issuing Date
Name

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, certifythatthis project is consistentwith the North CarolinaCoastal 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 252-946-6481
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT i
I hereby certify that I own property adjacent to (Name of roperty Owner}
property located at b b e-
(Address, Lo loc , Road, et -)
mil{.,,__/. Cr e-e-4 , in
on (CitylTown andl County}
(VNaterbody)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
have�bjacton_s_to this_p�oposaL_—_------------
NT
-_ --- DESCRIPTION AND/OR DRAWING OF l PROPOSED
DE of O M a site drawing)
(individual proPosr development must fill in description
N �JrL
H #r �a-r ay.
L
/AIRIER SECTION
- --
I understand that a per, dock, m oring pilings, brea,se, lift, of groin meet (If Sou
back a minimum distance of 15' om my area of riparian access unless waived by ( I
wish to waive the setback, you Mu t initial the appropriate blank below.)
I do wish to waive the V setback requirement.
_ I do not wish to waive the 15' setback requirement.
(Adjacent Property O�raer Information)
nation)
S1° r
Si�natu�e c,/l� �, C �� • r�
J�-
_ Print or Type Name
Print or Type Name F-s
9e o+ LU---------- iV(ailing Addre s �.� US-g B
Mailing Address 5
City/StatelLip 1 6 ,
City/StateyZi 7 9
Q ! 4 ' Z y? , 176 0 Telephone iVumber `
Telephone Number
Date RECEIVED
(Revsed 6/18/2012)
JUN 01 2021
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to N a As-sw s
(Name of Property Owner)
property located at 16 6 L Lil
(Address, L , Bloch, Road, etc.)
on && in s i' i.C.
(E:3ilaterbo y) (City/ T bwn a dlor County)
The appfcant has described to me, as shown below, the development proposed at the above
Iocatio .
1 have no objection to this proposal.
DESCRIPTION Ai DIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deveiopment must fill in description beSow or attach a site drawing)
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 f, Owner Inn oration),
Je G
Signatvre
Print or Type Name
;S 17 &Sr_onl- L. W
1V1ai "ny ddress
M r /� A 7 4 15
a. !V
ity/ ate ip
y19 :zq 7 jT 6 o
Telephone Number
Dad—�
(Adjacent P
atioE�)
Co�vt �i
Print e Type Name
Yo Rrc 1 St
MAddress
Mail'
a&
City/State2ip ;;
72 F -,Tss � �1V��
Telepho e A] mber
S�Z�A JUN 01 2021
Date
(Revised 9,% ,M#Ha CITY

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