Dockside Yacht Club - 91404C

At°"r' ❑CAMA ❑ DREDGE & FILL N° 91404 A B, G D
GENERAL PERMIT Previous 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:
I SA NCAC ❑ Rules attached. n General Permit Rules available at the following link: www.dee.nc gov/CAMAruIes
Applicant Name Authorized Agent f
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #
Email
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PINS Closest Maj. Wtr. Body
ORIN: yes(no) PNA: yes/no
Type of Project/ Activity
(Scale:,�Js )
........... .....
Access Length-
Pier(dock)length
,t,
Fixed Platform(s)
Cw
Floating Platform(s)
Finger pier(s)
j
1
Total Platform area
I
n
Groin length/#
)
-It
—I.
Bulkhead/ Riprap length
Avg distance offshore
{
4
o�r
Breakwater/Sill
—
_
Max distance/ lengthBasin, channel ! _
Cubic yards
L_
1
---
i
I
--'
—
—
—
—
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
—4_
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
—
—
—�--
O-
A building permit/zoning permit may be required by: �,a F-C� AIM I fr.l lF C,Q4AI
Permit Conditions' ''IGa 9ja F
IAM
Agent or Applicant PRINTED Name
THAT
Permit Officer's PRINTED Name
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature **Please read compliance statement on back of permit" ?
iL'��L
Application Feels) Check N/Money Order
Signature
Issuing Date
Expiration Date

❑DREDGE & FILL N9 91404 A B' C'. D
a GENERAL Previous permit
PERMIT
� Date previous permit issued
J 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:
Li „ I SA NCAC 1 . � '� / ❑Rules attached. , �. General Permit Rules available at
the following link: wwwc1eq.nc.gov/CAMAruIes
Applicant Name .)? w C-. C i e,4 Y"r L ti1'1 O/ Gt I-) Authorized Agent!-k U i l A G .+,S L
Address".nk/ ri �lX Project Location (County): ( !,-c•t_�-tc4T ,1
City l State A i ZIP 2�; > > 4 Street Address/State Road/Lot #(s)
Phone#(._) 'Ukt'%(')
Email --_----
Affected ❑CW
AEC(s): ❑OEA
ORW: yes no
OEW PTA
❑IHA ❑UW
PNA: yes/`o�
Subdivision
City A",ul't i,- of i+ ZIP
K
❑ES ❑PTS Adj. Wtr. Body ,,%-
.t.r- > -. 04
_ (naf/man/unk)
❑$PIMA ❑PWS Closest Maj. Wtr. Body , d411A C.1 .--
—.�
Type of Project/ Activity }'szn„k<+� . E ( „-0 r x : s J . I IA, 4 , /7 A SI•n
Shoreline Length
Access Length
Pier (dock) length /-`-
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/. Boatlift '✓ i '3'
Beach Bulldozing
Other
SAV observed: yes no --
Moratorium: n/a yes no --i - - Site Photos: -� yes no ?-
{-------
RlparlanWaiverAttached: ;eyes no L II
A building permit/zoning permit maybe required by: 0OU tu. r•L� Ott. ^)or �j;,( j
Permit Conditions' > )n 1'1t .1 ad{ (
(Scale:-($
❑ 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)
� Nc,,t.t '
Agent or Applicant PRINTED Name Permit Officer's PRINTED Na e
Signature "Please read compliance statement on back of permit`* Signature
Application Feels) Check N/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAPRA PERMIT APPLICATION
•tip ! :' .'
Name of Property Owner Requesting Permit,
Mailing Address- &A Y
Phone Number:
9
Email Address_
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
riacessary for the following proposed development 37
at my property iocatoo of
in er?: 4 : County.
1 furthermore certify that 1 am authorized to grant. find do in fact grant Permission to
Division of Coastal Management staff, the Local Permit Officer and their 1gcnls to eater
air the aforemenkmed lands in connection with evaluating infomttttion related to this
permit application.
Property Owner Information;
Title
Cale
r�F.crlv��
V52.3
T hfs cert�f{raston is valid through ��i t�,}�_I CITY

N.O. GIVISM OF COASTAi AMNAGEPdENT
AMACENT RIPARIAN PROPER T a OWNER NOTIFICATIONi WANF-IR FORM
CE?_ PI=C N.< +1J R= ; t.JP.N REi.F_ T r FM-E=S—ED or F'A+JG GE_i': Fft`
;T'-p Fprticn m be vxnpfored ny cwenez w t^3:r argentT
Val.: of ? v.,C::r C:•rs" �DOc•csici Y-! .n. lug
"*'ezcs +` I -'I _.pc^.;•, .301 Arent I'' St ?# - ,rad "ilr %IG 28957
e.11ny .=a1¢rasa of NG 2855'
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ADJACENT RIPARFAN PROPERTY 0%VXER S CFP.TIFICATICIN
.50ttorrl a6ftiott4Qh® :,rr t{%;l_, y tY� Adiazgnt rn�ge�4 4wn9zr
rnxc.: ci^S:_ 19rrt ¢rips ly a9.tr_q,r4 h :he a5ore! r�Iurz-c•.=; . ,e?1. T-a ird ;rjai app.yr5 `7( U4a
,.Me:l: t'.Iti m mA a-5 3-.'. r:r: nn !h9 �Zu i^�3:?,mr .. r. �. 3'3 �rrgr.i 'I'8'r are a•-1...
({1'i reo N nnwr- ::bie lrrn ,
! yar Hari• o5jecrions fo rihati3 5ftirg urcposed. yotr amtf =Vfy' the 0;S(1310t7 Ih CoM:ai
Aflorvarniant MCSit} if-, writing within ib ea%s of ritcipt of thJs +101rCo. CorrCmlcYO( da rC'C should Di
meited to QG Cmrma CA AYF-, MereheurJ City, MC 28557 t]CtAreprasrtn',itis+es can also ! Cco +iactee
at i252[A} 8ii8-'c8 +3. ho �csronse i5 co„s!d(rr�ad the samr, as ra Db&etion it you h. a Doer? notfft-cl by
oc,v,� ,d !ma;f-
WAIVER SE07JON
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do not %visnt3vixafia.,pe'i5�'�I•:..E.�;Ual.-.e. •�, II :I-t?I •I.5-��(� �� P1 1r%
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TypaBtPrinted hams at ARM. _
1tAiSlr:q Addeftat O' ARi'O! Chuck Falls
ASSISTAM IIIRECiCB PUBLIC SERVICES
GPO's ema:t� _
�-`�, �N ;2521726-6848
Dato: ` � _'wain chunk.falls@)mnrehcadcitTxv.arg
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N.C.INVISIONOr- COAST All. MANAGEMEWT
&DIACENT RIPARIAN PROP&ItTY IDWNER NOTIFK:dt4lgKWAIVER FOPM
Top,:'oft,•-t fo ,)o WMp1/3tc*i, tjy (rW, 9qr or rt*fr vent}
.,emr :,t i> x"clit C' w'r Qesch_3kM %A7 �It a I,
Wfjta-LtPrgw.°v. '& f?19IQf h:t him 'itY Wu^ 2 11 7
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:..G..:ACEI1T WIRAFOAM PkOPERTY OWNSR'S CERnFKATION
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r; you kayo obwt on.% to aatagt is #>oiflo propos" you nptn; ti06, oho N. �f J'Rsiori o�rG0—*ad
MQn4Yc'ft dt itt ) !n wrtirha,T wiihfll M 0oga arf0QVPt O!:Frit naNca Corruwdonca should be
;vaeiw to Aw coo m m-0 Ave.. Momho#deiry, Nc A"57. DOWrecrreaarttpfrss "n zagu bs mnrAc:rd
e RnJ NO.2500 !Vn m4pon se h contidored tote xeme as no oblarcfKm It you 1ravy boon notatlsd a i'
fw'filod Midiz
WAIVER SEC71 ON
utwertwid thti any mxvosec- ou, ox-k' fts"ina pdhvs. Dimt fall, fafeakwatar•. taarsrouse. rf, a
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