87457D-MJ VACATION PROPERTIES LLC

"Al 60"T4,%L7CAMA ❑ DREDGE & FILL ��� N9 87457 A B C D
.GENERAL PERMIT�JPar�tial
Previous permit
�Date previous permit issued
New ❑Modification ❑ Complete Reissue 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 �� — �} L)ci
❑tt Rules attached.
General Permit Rules available at the following link: www.dgq.nc.Yov/CAMArules
Applicant Name Ufa f t l 'tl� i F'S l
l C' U~tU .i t .'1 �,'s
Authorized Agent A C oCfV-) i
Address EPcy (NSU k CL ; e
is 0 e_
Project Location (County) +' ; I ao V-1 UV e
City ;i"RWJS State �� zip
Street Address/State Road/Lot #(s)
Phone # (` `)S) ►i 4 - S
���C)�G
Email
Subdivision V I A
city; 51nP ?)(9oxt'N zip _)KµKo
Affected ❑ CW ❑ EW ❑ PTA
ES ❑ pTS
Adj. Wtr. Body 1 i to j 7i 1 i i I P (
(nat�na unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
"�"r
I ncA
A 1 1,
(Scale:J`
Shoreline Length 50
Access Length K
Pier (dock) length
Fixed Platform(s) N ,
.......... ..... _.....
� I I
Floating Platform(s)
Fingerpier(s)
Total Platform area A
Groin length/# i Ti
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill r1
Max distance/ length N A
Basin, channel
Cubic yards _
Boat ramp t-
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: y_es no
Riparian Waiver Attached: yx-- no
A building permit/zoning permit may be required by:
Permit Conditions 4a l
t
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer'S PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Money Order
Signature
,L!,;, 1, , z ,t i I(II ? L
Issuing Date Expirati Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar - Pamlico River Basin Buffer Rules 1-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
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 — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHORIZATION FOR CAM&PERMIT APPUCA ON
Name of Properiy.Owner Requesting Permit:, S0 V Evans
MallingAddrow: MJ-0a Pe&VO, W'ne:
C;Ory�2liu5 1�[.G a803 �. ,
Phone Number: 8Z8) 914 - IW5
EmailAddress: �wyeva" [ 113 i� G►^^�,(. rDAg
1 certify that Uhave authorized ,�41A,42&' Jes'vM ii, 46,(
e..�..� n
to act on my behalf, for the Purpose of applying.for and obtaining'all CAMA perlmiss
necessary for the foIW. ngEoroposed development: i0r4 !kbM.e 4 a
at my Property beat at _ A&d ('+0e- r u_ hA.-
in AW. IerOycdrGourtty.
I furthermore cer* that 1 am authorized to grant, and do in fact grant permission to
Division,of Coastal Management aW the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating ft*nnaUon related to this
permit application.
Property inkmratlon:
Signature
Jp f �vahs
Or Type Name
Mtw6er Wwiaet
Me V
r.-
This oeitification is valid.through i j
0

{ a.P4 i i fT.��'it .ail r<.r+.�!+!'`•8'L;Su..;... :---�.. � —' t -r c�x.
ER STATEMENT
jaoerrt to
[hereby certify that I awn propWtY ad ' k c
.or Prop"'" ne"
property located at Ro
(.)
Addrna.Lctr Block,
.
on Ctv►1cS' C.L1GLtnnt'I ' i In ut N.G.
(Wabrtrody) (City/' and/or county)
The applicant has described to rrre, as shown below, the development proposed at -the above.lacatlon.
1 h
ave 'edl n to #rle propwai.
o
�T I have objedtona to this proposal.
DESCRIPTION /WD10R DRAWING OF PROPOSED DEVELOPMENT
(lnd Wdual proposing diawlopmWg must RN In dsscdpffon below or attach a slte. cl awing)
a
dru UTA(
WAIVE
I .understand. that a pier, dodo, mooting pMrgs, breakwater, boathouse, lilt, or groin must be set back a .
minimum distance of 16 from my. area of riparian access union waived by me. (if you .wish, to waive
the setback, you' . u hw the app>iopdate blank below.)
I do wish to waive the 1 & setback requirement
I :do not wish to waive the W setback requirement;
.(Property Owner InfoTwdon) is (Adjaeent Property Owrwr Information)
,: ,Sl e ' SY�wlroe
Print or
Mars
(Revised &1&2012)
t v. 5• F 1t>_ r xi.. - r z ����f` iR � "i t•a 4 4 t �r4". � � i" H.

MaCEA s
I hereby omttfy that I own property Ascent to
of
N.C.
on.tv� C:-ta�ne 1 In
(WshffbodY)
The QtWicant has described to me, as shown below, the development proposed at the above location.
�'._...t . have no objection to this propo.
I have objections to this proposol.
DESCRIPTION AND/OR DRAMNQ OF PROPOSED DEVELOPMENT
(IndYvidua! pmposlnq ciovafopmerrt most fill in descriptl m below ar attach a site dr*wing)
r
�11d �� WAIVER SECTION
I understandzt�__a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 16._from my area of riparian access unle<,ts waived by me. (if you wish to waive
the setback, you tit ,t i all the appropriate blank below.)
wish to waive the 15' setback requirement. 'r-U R, ZIgJliL�!"'} mpto C1 t�L-`'[
do not wish to waive the 15, setback requirement,
(Property Owner Information) (Adjacent Propwty Owner information)
Sign e _ Si crture
Print or N me Pt1nf or T Name
1p,,g Address TnOfdrem
'
L;"Y"'7t6) A� ,�i0(e''� 4t� ��4�C -:.--. A
Talepho a um r Tele hgne Mc ber
Date Date ..
(Revised 611W01 )

Date ReceNed
Date I)opwltGd
Check From Name)
Name of Permit Holder
Vend-
Check number
Check
amount
Permk Numberr/Commence
Receipt or RerundlReellocated
Columnt
Column2
Cdumn3
Co1umn4
Columns
Co/UmnB
Co1umn7
Cohnn.8
Column9
10/20/2022
David Grice Money Order
Bryan Daniel High etals
United States Postal Service
2.64E+10
$ 200.00
GP #8751 OD
BB rct. 18677
10/20/2022
Lighthouse Marine Construction Inc
matthews
Coastal Bank and Trust
4433
$ 400.00
GP #87781 D
JD rct. 17699
10/20/2022
Delta Dock & Boat Lift
Thushyanithan
First Citizens Bank
9435
$ 200.00
GP #87483D
JD rct. 17698
10/20/2022
Southeastern Coastal Construction C
MT Vacation Properties, LLC
South State Bank
12684
$ 400.00
GP #87457D
KB rct. 10374
10/20/2022
Carolina Bluewater Construction, Inc.
Kinton
BB&T
25568
$ 200.00
GP #87509D
BB rct. 18676
10/20/2022
Land to Sea Construction, LLC
Frost
First Citizens Bank
636
$ 200.00
GP #87675D
JD rct. 17771
10/20/2022
Richard Penny Construction, LLC
Jefferies
NAVY FCU
5220
$ 400.00
GP #87448D
KB rct. 10372
10/20/2022
Bruce Marek PE
Bald Head Island Club
Wells Faro
2306
$ 100.00
Ma'or Renewal Fee #108-17 BrCo
JD rct. 17852