Olde Town Yacht Club 87387C

CAMA ❑DREDGE &FILL NQ 87387 A e �D
& Previous permit
GENERAL PERMIT Date previous permit issued
14ew ❑ Modification ❑ Complete R 'iss e ❑ Partial Reissue
As authorized by the State
,�o, North
Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC . O i ._N 0 I Rules attached. ❑ General Permit Rules available at the following link: www deq nc gov/CAMArules
wzr►
Type of Project/ Activity
Shoreline Length I W- f— --
Access Length "—
Pier (dock) lengt
Fixed Platform(s)
Floating Platform(s►`�
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Si��
Max distance/ length
Basin, channel
Cubic yards
Boat ramp _" it sn : ; ; ;
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zoning f
❑ TAR/PAM/NEUSEIBUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See addldonal notes/conditions on back

oapF COASfq1Al NICAMA.[IDREDGE & FILL i s 873$7 A B o
4
y = GENERAL PERMIT Previous permit r-----
Date previous permit issued
[/Jew ❑ Modification ❑ Complete Reissue [:]Partial Reissue
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 NCAC _� '4' Pe ryo ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
City .t
Phone
Email
State Y� ZIP
Street Address/State Road/Lot
Subdivision
City ZIP 1
Affected ❑ CW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body IF. J -� 1 (nat/ an/unk)
-aI4,e
AEC(s):OEA IHA UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/ 41 PNA: yes/n i
Type of Project/ Activity '1 ' r
(Scale:
Shoreline Length t
Access Length �--
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)—
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore --
Brea
kwater/Sill�Z
Max distance/ length
Basin, channel
Cubicyards -^'---
Boat ramp ; Q tin J—
Beach Bull zm Vl�
Other
SAV observed: yes f
Moratorium: n/a yes Site Photos: yes Riparian Waiver Attached: yes
A building permit/zoning permit may be equired
Permit Conditions —�Z
I
C � 9-Plfii
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND
Ag rit eti-Applicant PRINTED Name' Permit O 'cer' TED N
I
nS'ture ** read compliance statement on back of permit** Signatu e
IL J
pplication Fee(s) Che #/Money Order Issuing Date
r��llyl. t
t�1. J
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
n Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: i 0
Phone Number:
Email Address:
I certify that I have authorized
<4-oi ,n ; vzq Gre--e A-
o
Agent /
. 40
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
go
at my property located at %Cto 4,)t?
in County.
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 with evaluating information related to this
permit application.
Property Owner Information:
(� i " a ur
Print or Type Name
�f 0
Title
Date
RECEIVED
This certification is valid through 7l6A_ MAY 13 2022
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to it)
(Name of Property OvMer)
property located at
(Address, Lot lock, RoLd, et .)
on 6�6- in 6� b� , N.C.
(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
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)
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) (Adjacent Prop ner Information)
Sign10A/-;� �r�
Print or Tye Name /J
�s-
Mailing Address
Teleph ne Number/ email add ss��--.,3r Date
"Valid for one calendar year after signature"
M " ' ddress
City/State/Zip
2S 2 . -2
Telephone Number/email address
S 22 PF 3FIVED
Date *
(Revised AuYN14)1 L- -?
DCM-I1I HD CITY

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MAY 13 2022
®CM-MHn r'aTV

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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: _ /y, G
Address of Property:
(Lot or Street #, Street 4r RWrd, City & County)
Agent's Name #: c-r G Mailing Address- 6 G 15 _r t/; -,tom
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual,
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A:description:or drawing with.dimensiom must`be provided -with this letter.
P I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at hftp://www.nccoastalmanagement.net/web/cm/staff-listing or by calling 9-888-4RCOAST.
No response is considered the -same as no objection if you have ,been notified by Certified Mail.
WAIVER SECTION
l understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15'. setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City! tate/Zip '
Telephone Number Email Address
Da
te
(Riparian Property Owner Information)
Signature
Print or Type Namq•;
5'er a
Mailing Address RECEIVED
City1&a 1zip MAY 19 ZOZZ
Telephone Number/Email Address DCM-MHD CITY
Date
(Revised Aug. 2014)

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9
if 17'
N
RECEIVED
MAY 19 2022
OGM-MHD CITY