Asbury Beach HOA Inc. 88551C

1+qj( t4j OCAMA ❑ DREDGE & FILL ® 88551 A B C 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. ❑ General Permit Rules available at the following link: www.deg.nc.gov/CAMArules
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Applicant Name r / 01, Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
ORW: yes/noPNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length J ...., __.._ _ _ .............__,. —
3 I
Pier (dock) length
Fixed Platform(s) i �fr Y) "71
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.
Beach Bulldozing
Other
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
SAV observed: yes no
Moratorium: n/a yes no {{
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Site Photos: es no — q
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Riparian Waiver Attached: yes no i
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A building permit/zoning permit may be required by
Permit Conditions
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(Scale:i ...r.,, )
❑ 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
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
Signature
Application Feels)
Check #/Money Order
Issuing Date
Expiration Date

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F(OASt4l EI CAMA ❑ DREDGE & FILL N9 88551 A B C
,Preous permit
y GENERAL PERMIT D to 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: www.decq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW
❑ PTA
AEC(s): ❑ OEA ❑ IHA
❑ UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
i`
Shoreline Length
Access Length
r
1
Pier (dock) length
Fixed Platform(s)
Y
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
— --
Breakwater/Sill
Max distance/ length
r
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
❑ ES ❑ PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
i
i I _
SAV observed: yes no
Moratorium: n/a yes no I
Site Photos: yes no 44
Riparian Waiver Attached: yes no .
A building permit/zoning permit may be required by:
Permit Conditions
nat/man/unk)
(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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
I
Name of Property Owner Requesting Permit: C.! - -� P,- -
Mailing Address:
Phone Number:
Email Address:
I certify that i have authorized
��� �•i �,�� r...�4.._ �7 -`j ��_ 1 ice}
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
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at my property located at
in l.� V - County.
l furthermore certify that l 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
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Print or Type Name
Title
/ 1
Date
This certification is valid through 1 l

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION)WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner; (`ram/ ( 1�-
Address of Property:
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Mailing Address of Owner: , _ r� I- }' ,r j ✓t �, �'
Owner's ema{{: '. Z&4 rr jWA-ij .(MOwner's Phone#:
Agent's Name: i- `' 1���' '` Agent Phone#:
Agent's Email:!") lY1 G
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Proegrtv 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
description or drawing, with dimensions, must be provided with this letter.
100 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 (DCAI) in writing within 94 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 noti%ed 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 b
(this does not apply to bulkheads or riprap revetments). (if you wish to waive the setback, you must sign
the appropriate blank below.)
100 wish to waive some/ail of the 15' setback Ldc�-
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-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's small: ARPO's Phone#;
Date:
*waiver is valid for up to one year from ARPO's Signature*
Rav>sad A.IcY 2029

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HANQ DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ; - -- t�� I UC C—,
Address of Property:"
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ry
Mailing Address of Owner:
t `�Ownees Phone#:
Owner's email. ��` •/l�v�-� �.-- :���'��°-�t`-� - -
Agent's Name: � 1 t � j_[6 i Agent Phone#:
Agent's Email: ;"
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom -portion to be completed _by the Adjacent Pro a 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
description or drawing with dimensions must be provided with this fetter.
,/, I DO 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. ®CM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been noted 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' setbackzzx , /C--
a�r.
Signature of Adjacent Riparian Property Owner
.OR -
I do not wish to waive the 15' setback requirement (initial the
Signature of Adjacent Riparian Property owner: rx� rrxif��-
Typed/Printed name of ARPO: f! Ir sn F
Mailing Address of ARPO:
onto
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waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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