64509_Dwayne & Patricai Burrows_20190711

0 CAMA / DREDGE & FILL Q# (o1'Sa�I No. 72429 A B C ,4)
GENERAL PERMIT Previous permit# /,)j4
��SNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued n1l/\
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 n l 1-i, Z a
1 J / ❑Rules attached.
Applicant Name b �I AI/► L4 f ATR)C)q 6 0 R((0►^r t' Project Location: County pi ML l e() CO I,i1 TY
Address �i i a 3 F2 0 j 1=)vCf, {Z 0 Street Address/State Road/Lot#(s)_ qi pZ 3 FGonf'c 1
City 11E91217r State /VC ZIP ;e Cc-4 R D
Phone# (757) 3.29 —//21 E-Mail Subdivision
Authorized Agent City MC R IC I o?e ZIP ��5 G
Affected -i]CW tigEW yPTA CI ES ❑PTS Phone# (7 S7) 3 Z,c1 "I 1 5/ River Basin
OEA ill HHF 0 IH ❑UBA O N/A Near" nat /man unk�
AEC(s): Adj.Wtr. Body /10012E 5 C R rl'j
- PWS: Q
ORW: yes / no PNA i yes,/ no
Closest Maj.Wtr. Body �' `7 el V C Z
Type of Project/Activity Awn-1 of/ 2 E p ) 1 )(Id / gQ A71 J o(I` ! o
(Scale: I I�Yo/ )
Pier(dock)length
Fixed Platform(s) i - 1 A
Floating Platform(s) — / 'a O d` ----.�
Finger pier(s) -- 44 9� - I
Groin length --- I . R !*1Yr1 ir '�L t
number I { , 1 � , � � to 1 [ . .
Bulkhead/Ripraplength '�'� ill) I
gt
avg distance offshore r- I- I w/ 6
us
max distance offshore 7 1 1 1 fr ij r�}) D ,
Basin,channel I O
Y1fi/d cubic yards 'r l lq S�^ Rtl ?
. 1 /
I -"r ---
Boat ram ` 3 3
thou Boatlift X/G 1 t r s !
—� t-liO �fP}��'
Beach Bulldozing �-'
Other
I . -4.
/Shoreline Len 1� 1v _i!l C .
SAV: not sur yes no j
Moratorium: n/a yes 1
Photos: yes n ,
Waiver Attached: yes '^ , /
A building permit may be required by: PA/4 -1 C C0 COU/J�1 / . n See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions s L 0-)4, 1 Z 00 P c jZ M i T C Or'D I O/✓ s, A L17)/0 g 1 E f 17 3.3z 17 2'
6 r 8o01' 1 L (T)1 A)0 -SOJ.LF SJ)C(AC rick 17) Xckf17 t/Orl
, F-e-, (.t Ct ,i t,.,.._} )<E U j 1-1 A R T
Agent or Applicant Printed Name Permit icer's Perinnttjedd�Namee '
____.t.c 7).--.),__
Signature **Please read compliance statement on back of permit Signature ( YY
Z00, 00 Lf'S` iLi 11,1Ly 0i4- 11 MeV Zo/9
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s)
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(910-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 9I0-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves: Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates,Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

I do not wish to waive the 15' setback requirement.
(P er Information) (Adjacent Property Owner Information)
•
Signature Signature
Print o7`Type Name Print or Type Name
'k 3 C—1 r< &L kJ.
Mailing Address Mailing Address
4)4 e.v r N C. Z
City/State/Zip City/State/Zip
-l— 7 33-' 113I
Telephone Number Telephone Number
11 • t e1
Date Duce
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to : T ct- ( 's
(Name of Property Owner)
property located at IA 1 2 3 110-V e \U. i d
(Address, Lot, Block, Road,etc.)
on u,)Y E S .�� � , in tjev6it , N.C.
(Watery) (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 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)
�.� Shy atl
40' P IZ'XIb�
0
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.)
I do wish to waive the 15' setback requirement_

Applicant: W 11N t- te' PA FRI c F'IZOv
Date: // fT-P1t ( Ztyi /
-General Permit#: z y Zg'3
Describe below the HABITAT disturbances for the application. All values should match the name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq.Ft TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
o c,i L W,Aes'J1I fL- Dredge❑ Fill 0 Both 0 Other J?z- t j q ZF
Dredge 0 Fill❑ Both 0 Other ❑
Dredge 0 Fill❑ Both ❑ Other ❑
Dredge❑ Fill 0 Both 0 Other 0
Dredge❑ Fill❑ Both 0 Other 0
Dredge❑ Fill❑ Both ❑ Other 0
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both 0 Other 0
Dredge 0 Fill 0 Both ❑ Other ❑
Dredge 0 Fill❑ Both 0 Other 0
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other 0

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1, 2,and 3. A. Signa ire
• Print your name and address on the reverse X 0 Agent
so that we can return the card to you. 0 Addressee
• Attach this card to the back of the mailpiece, B. Received b (Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
- �tS��c� If YES,enter delivery address below: ❑No
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IIII I III II I I I I I III III I I I I III I I I 3. Service Type ❑Priority Mail Express®
D Adult Signature D Registered Mail'"'
❑ ult Signature Restricted Delivery ❑Registered Mail Restricted
9590 9402 3811 8032 4749 02 aiwertified Mail® Delivery
❑Certified Mail Restricted Delivery ❑Return Receipt for
D Collect on Delivery Merchandise
2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation''"
isured Mail 0 Signature Confirmation
7 017 1450 0001 7561 3484 isured Mail Restricted Delivery Restricted Delivery
r o,ver$500)
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

USPS TRACKING#
'"iTJflftiffliu
First-Class Mail
Postage&Fees Paid
USPS
%. Permit No.G-10
9590 9402 3811 8032 4749 02
United States •Sender: Please print your name, address, and ZIP+4°in this box•
Postal Service
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N N v NC
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. • ature
• Print your name and address on the reverse 1 " 0 Agent
so that we can return the card to you. .410..iI IL! 0 Addressee
• Attach this card to the back of the mailpiece, Rec by(Printed Name) C. Date of Delve
or on the front if space permits. u nQ 6 t �oj-4 tie 1 2 4'
1. Article Addressed to: D. Is delivery address different from item 1? 0 Yes
V wCk- If YES,enter delivery address below: 0 No
k) V`a oK q51
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I I I I I III 1 I I I I I I I II IIIII' I III 3. Service�❑Addu t SignatureeRestricted Delivery 00 RrMail Express®
egi tered Mail Restricted
g
9590 9402 3811 8032 4748 96 certified Mail® Delivery
❑Certified Mail Restricted Delivery 0 Return Receipt for
Cl Collect on Delivery Merchandise
2. Article Number(Transfer from service label) Cl Collect on Delivery Restricted Delivery 0 Signature Confirmation,"
Cl Insured Mail 0 Signature Confirmation
7017 1450 0001 7561 3491 f Mail Restricted Delivery
500) Restricted Delivery
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

USPS TRACKING#
First-Class Mail
Postage&Fees Paid
LISPS
Permit No.G-10
9590 9402 3811 8032 4748 96
United States •Sender: Please print your name, address, and ZIP+4®in this box
Postal Service
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