89702A - Berta

�&es`°""1�❑N9 89702CAMA DREDGE &FILL A B
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 T Ili ❑Rules attached. ,❑ General Permit Rules available at the following link: www.cleq.ncgov/CAMArules
Applicant Name
Arirlr>tt
City
Phone # (_ )
Email
ZIP
Authorized ,agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City -
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wtr. Body r, ; (naymanjunk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PINS Closest Mal. Wtr. Body r",1 J i
i
ORW: yes/no PNA: yes/no
Type of Project/ Activity 1 4 S2 I-,, II
(Scale:
Shoreline Leneth
Access Length
Pier (dock) length
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Fixed Platform(s)
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Floating Platform(s)
Finger pier(s)
OEM
No
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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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature --Please read compliance statement on back of permit"
Signature
Feels)
Check A/Money Order Issuing Date
Expiration Date

Dop�$Ian Fm-Mp ID: 2E68G3BM5B1.I5DDdaABB5FA7I8B 6C1
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BSiEgIAIIIHORIL710N FOR us psnurc Aom �r TION
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Name of PMP" Owner Rewwflrlg Fwnn: Aax t A ,"ke, -
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Mai"Adde : t7 Qanddetl o+n
c Q),r� Ci O�s�11y
Phan Number: 4}lp0 9 oB 588tQ
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Errratl Address: ne4v
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I oeraty dart I have auftri¢ed QA� P,
Anent/C«beclor
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100 on mY beher, for the pumose of applying for and otgaining aH CAMA perm8s
.
r��ar�y'ror th�e��tab�wing�prpoppos�ed deval0prnerrt $i \1r �-. d � — - -
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a,my;-"- ylcataaa,
�CUYr� I. ,4c
in vye courdy. .
A"10f"We O&Wy dW I am authored to grant and do m fba gran# permMJon to
staff, Me Lwal FWrt* rertdtlreiragents onrer
tconnecfton
withOlfiw
evakrating irt/o/rrlation , this
related to Pennffapp&:edorf.
Property oarler imam atiDn:
h:
Bern
Aar"
vrrm or rypa mama
%fan
3 /14/20231
Date
I
This cealficalion is vaNd through
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
1� ' FI " MAID tt 'I )uN H f il)T H au s tLD or HAND OELIVEliy
Clop partlolt to be compleled by ()wile( (ir thn(r aqw)
'NOM11 •)f 11rOpel ly Ov{nrl Plum .
Aoulcss of pmj)ony: a`3-7 CLY'1bi . % C-Ov Oj , �� 51CID-1 .. _
f:;a)crc Adc10"i off 0wm+ , ///1'��� RUCUfA(N UQJ(-P,r.NO
t)OaC+.S Ornall:Vn��tl.+r�'`��lO
Aycnts Nrnnn(J(t () 1M) �,/,\ A{p:nt I'hnm+:it:_ O`,Ja q-pv.5--nq
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
($ottom Volition to he c.Mteted by the Adtacatit Pf omdv Owner)
n+�+ci)y cc;+bty that f mm) properly adjacrn)l to ese rfiuvo a)Imcu)reo YnMxemy, she fadsmdaat mpptymq:vs t)re:
pet Wit flag 09011ird to nx;, as sterns) on the attached thawurg. the development they are pronosintl. A
,rescr�itinn ol_tlra�_iit7fl, with din)ansinps, n ustbe pro_vpierl ytllh thr) felt()(.
11)() N01 have nblhrtmns to Thus ptOposai _ .I DO have ebjertions to a) pronax s.
t i aI jl you have objections to what is bebig p .?md, you must gl%y'the N.C. DivWm ofCoastal
Management (DCM) in writing within 10 dayi'Q1 racelpt of ibis notice. Cawrespo»derwe WKRW be
nestled to 401 S. Griffin St., Ste. 300, E/irabeth CItY, NC, 27008, GCU represer/fetives can also be
contacted at (254 264.3901. No response is tonaldared the name as no obj"llon N you hays been
notified by Certified Well.
W"R 6£CTiON
,,+idwsiand that any proposed peel, dock. montilg plih4ls, boat tarry), himlivratol. bualhousv. lih w
9,041 must be setback a adnimum distance of t¢' loom my area of ttpar)an access uuloss mined by till:
(this does not apply to bulkheads or riprap feveiments). (It you vAsh to waive the setback. you allud sign
the appropriate blank belmv.)
I DO itsh to waive so)nnlall (If the 15' setback_
Signature of Adjacent R#lsnon Property Omer
qR
I do not wish to waive file 15' setback Iequkemenl (011181 the blank),.
tilgt+as:uc tit Au)acem Hipatfail Ptopeny owflot
Typed/Pfinled name of ARPO: _......_.._..-.---- — —_ 41 k 1
Malting Address ofARPO: _.__ .......... okA-
ARPO's small:4S� %L'I
Date: . 1.1-_aisvalid for uptooneYetxfrom ARPO's8lgnatnre
Revised .1uly 2021
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