David Burroughs 72234D

(/ i ' ' '\701 K4 - --. (
toL,'CAMA / _' DREDGE & FILL NO 7-----
GENERAL PERMIT Previous permit# CD
)� q g C ew LiModification ❑Complete Reissue (-Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality iv-] i1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ��0- ( les atta`�'ed.
Applicant Name pt vr 9 e 0 g ���S Project Location: County 'E�'1/`.5/0 (N
Address qi 4?e h/a..5-4t - j .- ;( �f' Street Address/State Ro d/Lot#(s)
CityState ..ZIP 6p/lT /0 a (/
F.
Phone# ( ' ' 73/S E-Mail Subdivision_ /
Authorized Agent /L'k
k r t p2 4'/f(c City 7' 4 � " _ ZIP ZePr dO
❑Cw .1 EW # PTA DES ❑PTS Phone # ( �""' River Basin /4.1. C
Affected ❑OEA `❑HHF I ,0IH f❑UBA ❑N/A N �✓—Q
AEC(s): Adj.Wtr. Body pan /unkn)
0 PWS: N•-001" /j✓-P/L
Closest Maj.Wtr. Body
ORW: yes//lid\ PNA yes igia /�j/
Type of Project/Activity r f 4(.,Pq 4%l� - eci/6�" k
(Scale: �.-, )
dd4/ G,/� J �©
Pier(dock)length \
Fixed Platform(s) P. �/ ��, f�
Floating Platform(s) b ,< sd I j P y —
f..:_:
Finger pier(s) (0 � for I - ----;__-- __.._.
Groin length { .
P —
r _
number
Bulkhead/Riprap lengthfi/� Zf , I _ p MI -_ _-- .__I . __ _..__ .Y ._._.4.r
avg distance offshore ias ��—
max distance offshore i _ ,
Basin,channel _ ' l✓ A/V` OiR Of yll,A j,
cubic yards _
1
Boat ramp 1 I
;;;o:::::::Ift
In i W 11111.1W•
41
11=ra:
4
■
Shoreline Length I r'r too ( fib'
/'.
SAV: not sure yes no = E� �� `t/�Moratorium: n/a yes no r ��
Photos: yes no --� `7
Waiver Attached: ycle'1n�
_TM
A building permit may�belquired by: • w CO 1, See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
( 4 ' �(.11(C-� - �-_' ' p.,4 ,c_._. -
1 Agent orApplicant Printed Name P ' O cer s P( rinted Name
•
Ag
Si(4—'-- D '2/1 7-- ,)--
/ ture **Please read compliance statement on back of permit** Sign re
IV/ � �/ � 1' Y ,`i, 0 ./C .17 �. Zor /9
Applicationc Fee(s) � Check# Issuing Date Expiration Date

-tea
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /aC/C[ 6 Uro o
/ / f� ( me of Property 0 er)
property located at 162, hia,-/l / 0 t�//c.-
(Address, Lot, flock, Road, etcj
on t),,,,,,, ei,,,,,, , in X O tcf. Et i--/�� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
I have no objection to this proposalX
, , V‘--,
'S"\k 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)
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 initial the appropriate blank below.)
V\e'cl,i I do wish to waive the 15' setback requirement.
I do not wish to waive th 15' setback requirement.
jpti4ticic)
Pr pe ?w,nerform on) (Adjacent Property Adjacent Pro a Owner Information) t7
-- ----- sitt- ,. ._i\JNI, rQz 4 %r\A
S ture Signature
Print or yp Name f Print or Type Name I
7/.�2 < eb/�r� 7iai 4,n-P Li4,Ai4D l�tD ,` �G f
/ ailing A re �..� d , Mailing DS F.Ei
ic 1e a /2I r
Ci /Sta e/Zip C►&State/Zip
57/-, 73/S ecio v Is,.&veit-01,12-1 `i /io-S4)/-/"7 7?
Telephone Num r/ ail siddress Telephone Number/email address
/V 2- /P I6--,, zi- /se
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -)Gt(2,bt 00 r L.-) `c.5 's
, // // sra of Propertyc Owner)
property located at ��c 3 /71.?://�i r)c -I�o
(Address, Lot, Block, R9ad, etc.)
on A9e C) 1e/ C.0 t✓� , in )/'t 2cc C(S 1yj-/ - , N.C.
(Waterbody) (City/Town and/or ounty)
The applicant has described to me, as shown below, the development proposed at the above
to . ..n.
;i I have no objection to this proposal.
I have objections to this proposal.
����� DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
V
(Individual proposing development must fill in description below or attach a site drawing)
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 initial the appropriate blank below.)
WI do wish to waive the 15' setback requirement.
' '' I do not wish to waivethe 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Vied,',
Signature Signature' ,*,�//�
Print or Type Name Prinf fill
or T pe Name 11
H% UAW;k1� if ,ether.
Mailing Address Mailing Address a�� f �{
Wire i1
City/State/Zip City/State/Zip
40-91)--Dfit)-
Telephone Number/email address T�� /e Number/email address
Date Date"
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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