Berry, Mark 91152C

#F-]New
❑CAMA ElDREDGE & FILL N9 91152 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ 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.deq.nc.gov/CAMArules
Applicant Name Authorized Agent /
Project Location (County):
Street Address/State Road/Lot
l
City
Phone # (
State ZIP
Email -' Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body i t ! % (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body. I
Type of Project/ Activity 1
Shoreline length ; (.i
(Scale:i y )
Access Length
'
�
a
Pier (dock) length�-
Fixed Platform(s)
I
`
Floating Platform(s)
Finger pier(s)
�
)
I
i
fLl
I
_I
Total Platform areaGroin length/M
;_
i
4
Bulkhead/Riprap length
Avg distance offshore -L -
_
_
_
-----
--�
-f
-I
-
Breakwater/Sill-
Maxdistance/length
Basin, channel s' I ( "�-
Cubic yards
.I r i„'\--
I'
Boat ramp
-�
-
-
4L
Boathouse/boatlift
Beach Bulldozing
Other
I
5AV observed: es not
y dI
Moratorium: n/a yes no -- -
Site Photos: yes ino� ! -
Riparian Waiver Attached: yes no•.
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A building permit/zoning permit may be required by:
Permit Conditions
(
❑ 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) r
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
Application Feels)
Check h/Money Order
Signature
Issuing Date
Expiration Date

#F-1
❑CAMA ElDREDGE & FILL N9 91152 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 _i ! "i_ ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq nc goy/CAMArules
Applicant Name _
Address
City
Phone # ()
Email
Authorized Agent
Project Location (County): "
j
_ZIP Street Address/State Road/Lot#(s)
Subdivision
,
City ZIP
i
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wtr. Body i (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW'ves/no
Type of Project/ Activity
(Scale:/ )'
Access Length
Pier(dock)length-
—
!
—}
�-
—
—
Fixed Platform(s)ff
__
Floating Platform(s)
Finger piers)
r
Total Platform area
Groin length/q
Bulkhead/Riprap length ---i-
-------.
-�---
.�
Avg distance offshore �
--.---
(I
'1
-
—
---
I--
--
----
Breakwater/Sill-
_.�.
Max distance/length
1
—
1
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlik
Beach Bulldozing
i
Other
i
k,
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
❑ TAR/PAM/NELISE/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 APPLYTO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
1
Signature **Please read compliance statement on back of permit** Slgnat`tre -�
Application Fee(s) Check#/Money Order. Issuing 'pate ! Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
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CkQv l.t kowc"y ( Caro\' a� S V-,.) c'%
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:o L G is
"Y_
at my property located at IS, %cbecviLac tNc _ t7�c ICuo�l 54 nm;t,
in �a< 4c ce} County.
1 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:
PLC - &2'�
Signature
Print or Type Name
Title
Date
This certification is valid through / / FFB 16 f
oum-name; t I i Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rn«c-k lie 's
(Name of Pr erty Owner)
property located at /52 A-boev; 4-c.� �r
(Address, Lot, Block, Road, etc.)
on , in 5ho1C.S N.C.
(Waterbody) (CityfTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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JO WAIVER SECTION
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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
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Si n lure
Print
t %'T' fy Te
nit ess
Ciy/State/Zip !, � I ZV vim+
Telephone umber/ email address
`-('-20-7-3
Date
(Adjacent Property Owner Information)
Signature*
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date*
(Revised Aug. 2014)f is 16 -[
'Valid for one calendar year after signature*
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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
Address of Property:
Mailing Adcjress of OIwne
ma-rlC��!'jrnaTI�2�C�n12r('�
Owner's email: Owner's Phone#:� 2 0
Agent's Name:
Agent's Email:
Agent Phone#:
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
description or drawing with dimensions must be provided with this letter.
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. 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
-OR- Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank) \�A
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
�Iz
Mailing Address of ARPO: \ �— y SJ,��x I \' C
ARPO's email; (A�G �J ��bc�LC ��' "ARPO's Phone#:
Date: . `�y�3 *waiver is valid for up to one year from ARPO's Signature
— Revised July 2021
t- 5 ¢i C'

.7
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:
Vz-
Addr oProperty: L5 41
j k0
Maill6g Ad, ress ofpQwrier. 5 A 6W
11riy({(ca�jyi�c�T11@C(2GilJ2r(�i(QrCoYV\C� �'
Owner's email: Owner's Phone#: b
Agent's Name: Agent Phone#: /
Agent's Email:
i
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent ProoGmy Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
)ermit has ;described to me, as shown on the attached drawing, the development they are proposing. A
lescrilJtion :'or drawino. with dfmonefnnc :»„ter Ke .....-;; -A —.. ":_ _
rl I!IDO NOT have objections to this proposal. I DO have objections to this proposal.
If yori� ha objections to what is being proposed, you must notify the N.C. Division of Coastal
Mansggemebt (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
mai/eg 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 /f you have been notified by
Certillpof MAg.
I 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 sian
the appropriate blank below.)
I DO wish to waive some/all of the 15 etback
T
OR- ign tur of djacent Ripa " ope wner
ai din
I do not wish, to waive the 15' setback requirement (initial the blank) �
�Qh(eS. �3ti{1a
Signature of Adjacent Riparian Property Owner:
Typed/ rinted name of ARPO:
Mailing AddressofARPO;_ hjT o&pe �,
ARPO's! ma e U�/2 e�aKJr Llc ARPO's Phone#: L f . S q �• ��t lrl� J
l
Date:
*waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021
FEE 16 rut
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