83820C - Brooks Creek Marina HOA

❑ CAMA / ❑ DREDGE & FILL 9 83820 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
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name s j� ;- "` �r:?' Project Location: County
Address '. , f.... Street Address/ State Road/ Lot #(s)
City State ZIP
s t V).1/1
Phone # ( ) E-Mail Subdivision
Authorized Agent 4 t'� r.' i. x z k ;.• City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # O River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity (, 's
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/ Boatlift _a f
Beach Bulldozing
Other
Shoreline Length
I�
SAV: not sure yes no r-...--
Moratorium: n/a yes no
Photos: yes no
i
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or.Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: )
❑ See note on back regarding River Basin rules.
PermitOfficer's Printed Name
Signature
Issuing Date
Expiration Date

❑CAMA / ❑ DREDGE & FILL
I? 83820 A B C D
GENERAL PERMIT
Previous permit#
❑New ❑Modification ❑Complete Reissue
El Partial Reissue
Date previous permit 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 I SA NCAC
Rules attached.
Applicant Name
Project Location:
County
Address
Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) E-Mail
Subdivision
Authorized Agent
City
ZIP
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # O
River Basin
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
(nat /man /unkn)
❑ PWS:
Closest Maj. Wtr.
Body
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) lei
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg distz
max dist
Basin, channe
cubic ya
Boat ramp _
Boathouse/ B
Beach Bulldo;
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attacl
A building permit may ue reyuireu uy
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Signature
(Scale: ) I
Issuing Date
Expiration Date

y
lo
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C

r WACEi'� T RIPARIAM PROP E-IROWMER STAB EMEM
I hereby certify that I oven property adjacent to �/'b�0�s �'�4-��'�SiJ
/(Na, e e3i l iro we dy C'bv 7i /
property located at
D 3 %
��yY' 'Address, Lo , Bloc , I o�d, r
on ks -, in.
t�l'riatevbody ��i t1 owe a dl® Coea S�r,
The app " ant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
I hawp r)hiaCtiLo_o-s-�0-this-pro.p-o-sal---
DESCRiPTION AND/O;R Df L�a1111iNG OF PROPOSED DEVioLOPIVIEN
(€� iFrid ,T�t' prop€a�a y deveiopmept :nuat hill in desarspti©na Wow or afacl-I a site drawn?g)
m
tf �'i '=F ����, � iON
!.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 rr ust initias the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I d10 raot wish to waive the 15' setback requirement.
Ear opeeq Owner Inf0rmaltion'D (F�d�a�e�t Proper�i� �t�VfTieG' ufi��d�7 ���9®n
1
Siatu; 41 i ture.19're"4 I�"Jt1.JJe'A 6�&"
;
Print or T}gyp NaT
Pi-1,5-
nt or Type Name
1,4
, L J
/ C, C'k P,
lit/1-adfirty- ddre � C �g5,3 I (jai ' Ad ess Ai- keJfS a e S�'3 �
QY'
sty/atenip . r ., „ C 17/ate/Zip
Telephone Number
q- 21• Ao27--
Date
Telephon Alumber
h Z
Date
(P,evised 61 o/20'i2)

ADJACENT RIPARIAN PROPERTY OWNER STA/TEM1 N /
I hereby certify that I own property adjacent to S ds' �� ld5s s
(Na eofP o erty caner)
property located at
1J/� (Address, L IS k, Road a c.) n n
on
(iJVateebody) (City/fown andl6r County)
The app scant has described to me, as shown below, the development proposed at the above '
locatiopl
�/ 1 have no objection to this proposal.
DESGRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or afiach a site drawing)
.010
b6c i
wd Ik
,ate
WAIVER SEGTION
/.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 Owner information) (Adjacent PWGI Ovunor Information)
Si aNwe
Name
3!
Telephone Number Telephone Number
3-14--2.2.. MAYCh t4,2022
Date Date'
Revised 611812012)
252-2-

AGENT AU HORiZA It ION FOR CAMA PERMIT- i
Marne of Property Owner Requesting Permit:S
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
I
Agent/ Contra tor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
0
2
at my property located at Z%h�
in a_,� ounty.
1 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 Mth evaluating information related to this
permit application.
Propel Owner Info
Signature
or Type Name
Title
v
b / 2,o2Z
Date
This certification is valid through / �13 3 ( i Zz,