74302D_BURNHAM, Mike

,
. 6d CAMA/ ❑DifRElbGE & FILL No. 74302
A B C D
GENERAL PERMIT Previous permit#
>' )(New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality l i1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /�� /,2,C7(/
El Rules attached.
Applicant Name / /�' e it,/2>iA79/*2 Project Location: County t"hh/ ,#tea ' 2
Address 8 3.-40/1 'P 72x Street Address/State Road/Lot#(s)
City 1,./et,hMS U//fie Bci State/VC.ZIP '2 0 %U 5'9,,
Phone#(9/r/)269 Y/s27 E-Mail Subdivision
f')
Authorized Agent 9R .' /,e Cie/7', City ZIP /I
❑CW jJW )'PTA ❑ES ❑PTS Phone# ( ) River Basin/ `jJ J t' 062E
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body fiOili <1J
S 9/01NP/ na /man /unkn)
❑ PWS:
ORW: yes /ono PNA yes / Closest Maj.Wtr. Body l✓w
Type of Project/Activity C(iitiSTi'oc7 Apes. 1 Pieg, Pi,/ fc1z,' , I1G!9 1,.�, Deck
4" Yol71 r71' (Scale:/ irr20 , )
Pier(dock)length lC 25
/
Fixed Platform(s) lb///6' ' ! ; t
Floating Platform(s) 7 6 ' /�•+�D 4 /41;t ''1{""` //�
Finger pier(s) j I I
Groin length r I
number
1 /3 ' t 1
Bulkhead/Riprap length S' Q ' 1 (
avg distance offshore
i t O 'i
d
max distance offshore 1 O3
14 ,
Basin,channel i f . I�
i
i
1 I J—.._ ,
cubic yards I �11.5.r."1 J."'.1.5
Boat ramp 1 St4/94 l i rfb*k
Boathous Boatlift / ?[ 0' —i ...... t I ! --
Beach Bulldozing I I , - i
tJ Other W 70;f4. )(‘A + '
01
, ' I— I IF Is! J l
L, : _. f �_ AIL-
Shoreline Length SS
SAV: not sure yes r : gr"--— - i -- --- --
i
Moratorium: n/a yes ,? 1 1
Photos: yes , Q . e L —
Waiver Attached: yes @ / l 1 n T 1
A building permit may be required by: W��4/j7S ✓//1 e 2?'s' 4 . I I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)` J L 1 J
Notes/Special Conditions J/Q U C/U2 e S j'A )/ NO 7' E ti C 2 G 9L�J / ✓`�7 O f 4e /gri AC P.✓1.
/5" ',/fn4/19N eaglli0✓0./1.1e )1/ICEr,
"1-1/1/4"- 64 m r i' S Pie w,L sG -'
Agen plicant Print Name Permit Of icer's Printed Name
^2
Signature **Please read compliance statement on back of permit** Signat re
- 2 G — I..3712 ���f//� 00,
• Fee(s) Check# IssuingDa Expiration Date
Application

Letter of agent
I M L}1tae- 04 have retained Mark Clements DBA. Clements
Marine Construction Inc. to make application for any and all permits needed to start
construction on the work requested for our property or properties.
By allowing Mr. Clements to make such applications I do understand that this will in no
way relieve me of any obligations to perform all work according to the building codes of
North Carolina. CAMA. DWQ or any other state and or county ordinances.
LAnG&_I U�i c-v) h �<<.
Print name
Signature
r/O -7LQ-y527 date 3/79/07.
Contact information
Cfr ; pCOr1)rv)
RECEIVED
APR 042019
DGM WILMINGTON, NC

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: j.gi,er(\11o►r1'N
Address of Property: Lot. e .Shore do 1,3r'i141i3v iOc- 1 IO
(Lot or Street#, Street or Road, City&County)
Agent's Name#: bemefb Mailing Address:
) GkrG1e criwe..i 1469 .95}ec.a, f0G-
Agent's phone#: I D -102-O - a 5C 5J'
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.
x fi '( I have no objections to this proposal. I have objections to this proposal.
tiqK
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. Contact information for DCM
offices is available at www.nccoastalmanagement.net/contact dcm.htm or by calling 1-888-
4RCOAST. 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, 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.) RECEIVED
I do wish to waive the 15' setback requirement. APR 0 4 2019
K I do not wish to waive the 15' setback requirement.
q-K DCM WILMINGTON, NC
(Property Owner Information) (Adjacent Property Owner Information)
020,21 gi4roi/147/9-rn/
Signature • Lure (,, n

Print or Type Name Print or Type Name IQ /3 /< O r tl eq 4 j
C -c/ C'1i/ � 30 <
6 L� Lr GJ cod ��c 3ur�
Mailing Address Mailing Address
/,t u %dc/io9e 20 {3 I") n s.ed n a :n N
City/State/Zip City/State/Zip
(-2 914S 3.3 6 - — 3 )
Telephone Number Telephone Number 3 3 E /3 _ 3(F/.3-Ac-/9 4 / / // 5
CC)
Date Date
Revised 6/18/2012
RECEIVED
APR 0 4 2019
DCM WILMINGTON, NC

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DCM WILMING1ON, NC
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Check
Date Received Date Deposited Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Receipt or Refund/Reallocated
I Column? Column2 Column3 Column/ Co/umn5 Column6 Column? Column8 Column9
5/6/2019 Clements Manne Construction Inc. I Mike Burnham _First Citizens Bank 5117_3 200.00 GP#74302D DW rct 6164

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A. Signature ����
• Print your name and address on the reverse Ogent
so that we can return the card to you. -Lug i El Addressee
■ Attach this card to the back of the mailpiece, B. Received by(-rinted Name) C. Da-of De'very
or on the front if space permits. 3 O1 •
1. Article Addressed to: D. Is delivery address different from item 1 0 Yes
If YES,enter delivery address below: 0 No
4L.o1zo orf\ecicv
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70 1<ir n E= pOr< r
0,105 cn 5ek.1e►mi n� 671vb
II IIIIII IIII III I I I I I I II III II I I IIII I III I I I I 3. Service Type 0 Reg ty Mail ail",
❑Adult Signature ❑Rgistered MiITM
❑Adult Signature Restricted Delivery 0 Registered Mail Restricted
ZrCertified Mail® Delivery
9590 9403 0737 5196 1754 44 0 Certified Mail Restricted Delivery 0 Return Receipt for
❑Collect on Delivery Merchandise
2. Article Number(Transfer from service label) • 0 Collect on Delivery Restricted Delivery 0 Signature ConfirmatlonT"
Insured Mail 0 Signature Confirmation
2 710 0001 0137 8323 Insured Mail Restricted Delivery Restricted Delivery
;over$500)
PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt