Olde Town Yacht Club - 90075C

❑DREDGE & FILL Nv 90075 A B C D
GENERAL Previous permit
PERMIT
� Date previous permit issued
:New ❑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 '/ % ❑ Rules attached. ❑ General Permit Rules available at the following link: ww.•wdeq.nc.gov/CAMArules
Applicant Name-lne-UM Authorized Agent +ale`
Address - Project Location (County):
City State ZIP Street Address/State Road/Lot #(s) "%• "' [�
Phone # ( )
Email Subdivision -
City ZIP .y
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body / `
ORW: yes/n5 , PNA:yes/no ,
Type of Project/ Activity
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s),
Floating Platform(s)
Finger piers) '
Total Platform area
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore ..
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
n I
(Scale: H O )
❑ 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' Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date

°�`°"" ❑CAMA ❑DREDGE & FILL N° 90075 A B.� 1 C
GENERAL PERMIT Previous permit
Date previous permit issued
4New ❑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:
I SA NCAC -- 0 ❑ Rules attached. ,W General Permit Rules available at the following link: www.dec.nc.gov/CAMArules
Applicant Name
City State ZIP
Phone# (; S L) d 1jGi'it
Email ", 7'/C h'. ,.�hL r'�:r raz r o —
Authorized Agentir' ,`_.i o,.•�`Ffc1d3
Project Location (County): i
Street Address/State Road/Lot #(s) `! -< ��- • ) �,
Subdivision
City /
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. W[r. Body el.:± -I � f (FeT]man/unk)
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Maj. Wtr. Body iA-%e ..<- =�' V I'LO
ORW: yes/n6 PNA: yes/no
Type of Project/ Activityi, C� n
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s) �—
Floating Platform(s) --�"
Finger pier(s) M Y 50'
Total Platform area - --
Groin length/#
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill —11
Max distance/ length
Basin, channel
Cubic yards -•�'"
Boat ramp ['
Boathouse/I[cm f:
Beach Bulldozing -
Other
SAV observed: yes no
Moratorium: n/a yes no..
Site Photos: yes - no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be r(
Permit Conditions
(Scale:! = N J )
U IANrPJ1NtUat/5Urrtn tame 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) K,T
Agent or Applicant PRINTED Name
Signature **Please read compliance istatement on back of permit"
Permit Officer's PRINTED Name
Signature
Application Feels) Check#/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Olde Towne Yacht Club
Mailing Address:
Phone Number:
Email Address:
100 Olde Town Yacht Club Rd., Beaufort NC 28516
252-726-3066
[e-mail]
I certify that I have authorized Carteret Marine Services LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 20ft extension of finger pier & Install new boatlift
at my property located at Olde Town Yacht Club Slip E16
in Carteret County.
I furthermore certify that 1 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:
Signature
Leland Rychel
Print or Type Name
Property Manager
Title
04 105 / 2023
Date
This certification is valid through /.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _Cosmo's Dock
Mailing Address:
Phone Number:
EmailAddress:
2054 Kildaire Farm Road # 426
_Cary_,NC 27518
984-389-6972
[e-mail]
I certify that I have authorized Carteret Marine Services Karl Taylor /Jimmy Johner,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for thg(ollowing proposed
at my property located at Old Town Yacht Club Slip E16
in Carteret County.
20ft extension of finger pier & Install new boatlift
l 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
i
Signature �3
Print or Type Name
Title
XlZ1—/ 2 Z_3
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Cosmo's Dock
Address of Property: Olde Town Yacht Club Slip E16
Mailing Address of Owner: 2054 Kidaire Farm Road #425, Cary, NC 27518
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Carteret Marine Services
Agent's Email: [e-mail]
Agent Phone#:[phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certifythat 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 dimensions must be provided with this letter.
='T60 NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
of Adjacent Riparian Property Owner
IRQ?
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: , -�•p / r • d ��q
Typed/Printed name ofARPO: Tao C. i✓a�ro1
Mailing Address ofARPO: 2Yaz Bva rt Oivp Ko- 2V461
ARPO'semail; e - ARPO'sPhone#: 5'ra?s6 (fcd
Date: 31 M- "- `(' -Z'Z3 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. Cc)gmn'a Dock
Address of Property: Olde Town Yacht Club Slip E16
Mailing Address of Owner: 2054 Kidaire Farm Road 4425, Cary, NC 27518
Owners email: [e-mail] Owners Phone#: [phone]
Agent's Name. Carteret Marine Services
Agent's Email: [e-mail]
Agent Phone#,252 631-9435
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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
NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28657. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 16 from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments) (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank) f'
Signature of Adjacent Riparian Property Owner
Typed/Printed name ofARPO:
Mailing Address of ARP0.
ARPO's email: _ Gt r' �'tern Z S / 7
14' _�C( EJI+ CO�.� t ARPO's Phone#; � l
Date: 4 `0r/ c 5 —*waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

WAKE COUNTY, NC 61
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED 8 RECORDED ON
03l1012023 16:26:00
BOOK:019281 PAGE:e1813 - 01814
ASSUMED BUSINESS NAME CERTIFICATE (NCGS 666-71.5)
Please print legibly.
1. The assumed business name is: (6q f S
(You may include no more than five (5) assumed business names on this form.)
2. The r,Qal npme of the person of ent4 engaging ip business under the assumed business name is:
(Corporations, LLCs, limited partnerships must provide the exact name registered with the NC Secretary of State's office and
the SOSID number assigned at the time of formation.. Go to www.sosnc.gov/brZsearch to look up your information.)
3. The nature/type of the business is:�n'�i,l
4. The street address of the principal place of business is: (PO Boxes are not acceptable)
5. The mailing address, if different from the street address, is:
6. The counties where the assumed business name will be used to engage in business are:
XAII 100 North Carolina counties
This certificate is signed by the
this 10 day of
Signature:
Printed/Typed Name: f"1
Title:
egal representative of the person or entity named above,
20Z-> .
(See instructions for who milt sign for various business entity types.)
Assumed Business Name Certificate
10.03.17