78041A_Perry, Jr., George D_20210226

® CAMA / N DREDGE & FILL
GENERAL PERMIT
RNew ❑Modification 0Complete Reissue 0Partial Reissue
N ° 78441 <@1 B C D
Previous permit #
Date previous permit issued
As audwmed by the State of Nwb Carolina, Department of Environmental Quality t�
and the Coastal Resources Commission in an area of environmental concern pursuant to ( SA NCAC / N
Rules athdwd.
Applicant Name_* �._ Y �r�-5C•
Address_1_0!7 4 . N ml Z Reach I?tL—
city C Cie re n state JjC zap 27��y
Phone # (JUL) 211 - 5 76q E-Mail —"
Authorized Agent �DiS T rj
Affected C Cw NEW ® PTA In ES 01 rrs
AEC(s)• 0 OEA U HHF D IH O USA ❑ WA
0 MS.
ORW: yes /(Co) PNA yes I @
Project Location: County Lr�, e
Street Address/ State Road/ Lot #(s)
Subdivisions Cryp &cr h
City Ccl��ct�in Zip 2 r�
Phone # (") River Basin C►10WP r,
Adj :Wtr. Body C iti f,,661 i2 4er Moots lunkan
Closest Maj. Wtr. Body HtI"-,a L 50�6 .A
Type of Project/ Activity at15IY'. (�� `3' Gt l�t?>w U��X �G` G�
(Scale:
Plar(
Fbced
Flood
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Phot
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A building permit may be required by: .r -bi t l QLc I rl, ❑ See note on back regarding Rtvw Basin rules.
( Note Local Planning Jurisdiction)
Notes,/ Special Conditions
A . M. 4
Agent Appliant Primed
siguwre "Please read cornpuncAtaternentonbackofpermtt�
Application Feels) Check #
__-_ OW m et fi t► t4 �
Permit tx'sP�rinud
!ri
Si %-
2/ Z(a/Z(
issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: 04 - -6 , --
Mailing address: L-04 5
Czt�j 2:
Telephone Number:
I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of
at my property located at
This certification is valid through 1 1 (date).
(Property Owner Information)
Signature
Print or Type Name
--
Title, coowner or trustee for property
DJte
Telephone Number
Email Address

DIVISION OF COASTAL MANAGEMENT
Recd'> ACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
2 1 Z CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
tG Property Owner:
Address of Property: �C) q S %'e�'�
(Lot or Street
Agent's Name #: n f vc-,/ f
Agent's phone #: 6-Z — 2 O Z /' Q7
kW
or Road, City & County)
Mailing Address: 5iZgCcak �
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 dimensions, must be provided with this letter.
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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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 sign the appropriate blank below.)
(Property Owner Information)
Signa re
Print or Typ Name
1 0*7 S F,,rrys ill
Mailing Address
Cc (e rcA AJC Z�-t2 �(
City/State/Zip
2,5Z 2-l-7- V[7
Telephone Number / Email Address
/Z-/0-Z0
Date
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Signature
ILT_"S bejU ;
Print or Type Name
i`lo I vJ4:
Mailing Address
OJ�
City/State/Zip
'4� )- --40`i_
Telephone Number / Email Address
q-jb '�o
Date*
"Valid for one calendar year after signature*
Revised 2017

R�CE`��� DIVISION OF COASTAL MANAGEMENT
JACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
utt; 2, 1C_ ,ERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
DCIA,LQf Property Owner:
Address of Property:
roe
(Lot or Street #, Street or
r kr Tv -
s g6t-, Cti
id, City & County)
Agent's Name #: �fMailing Address: %;y Sg(�-C 4 0 C�
Agent's phone #: Z� Z � Z ! �5-6-7 2 /� ff
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit haamOescribed 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.
V 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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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 sign the appropriate blank below.)
(Property Owner Information)
Signat e
Prin or Type Name
Mailing Address
City/State/Zip
ZS-z Zip-2�oc-7
Telephone Number / Email Address
(z-(O -
Date
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
A
(Adjacent Property ner Information)
,Z�a o.
IS /g re
Print orpe Name f
1� ✓�
11Z /"A/o�-�
Mailing Address ,//
2701 2— Cf
City/State/Zip
LZSZZ�) 2\-7— 2;-0 1 6
Telephone Number/Email Address
12/1/zo
Date*
*Valid for one calendar year after signature* Revised 2017

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ConnectGIS Feature Report
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https://bertiecounty.connectgis.coni/DownloadFile. ashx?i=_ags...
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BertieCounty
Printed January 25, 2021
1
Nk-_ ' Total Length: 519.25 Feet
S . ' : 28 Feet
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Misc Parcel Lines
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LEADER LINES
LOT LINES
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RAIL CENTER
SUBDIV BLOCK
SUBDIV BNDRY
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I of 1 1/25/2021, 11:06 AM

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