73879A_Burke, Frank_20191001

©CAMA / 0 DREDGE & FILL
GENERAL PERMIT
©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 pursu
Applicant Name Vr CG n iCC zu c- k e
Address p1 o is C-4 .
Ci1 Jr, State kJ C ZIP ;? _g 3 Z
Phone # (q,2`1e) S95' LI) /U E-Mail
Authorized Agent s (-(,CI d -its
Affected ❑ Cw ❑ Ew m PTA ®ES fi� PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
ant to I SA NCAC
No. 73879
J�p ✓
(A), B C D
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County C 11 v,_J0,,►1
Street Address/ State Road/ Lot #(s) Loi S
C�
Subdivision e r,\ a cI, fN P1,
City ( -e\ V0A ZIP R-713;Z
Phone # ( ) River Basin
Adj. Wtr. Body A `;r Oct,._. at, man unkn
Closest Maj. Wtr. Body I b� e
_■■■p��1•■�■���11�■�■■■■■■■■■■����■
Ill■■NN
■■■■■■■■■■■■■■E■■■
■■■■■■■■■■■M■■■
■■■■■■■■■■■
■■■■■■■■■■■■N■iili�l�ill■■JEil■
mum
WINE
■�■■■■■■■■■■■w■■■■■■�■�■�■■■�
n■■■■■
11111111
NINE
l
MEN
IN'..0
.=
10,
SEMEN
i■■■■■%■Y/■
■■■
■■■SIM■■■■■■■■1lYY'li'%an
• JIMM■■■■■■■■M■■■=
�■E8■■■ MEMO NNE
.■■■■�■■■■�■■r■■■■■■■■■■
■one■
s
Agent or Applicant P int^ ed Name
Signature Please rea compliance statement on back of permit"
Application Fee(s) Check #
PermitOfficef's Printed Name
Signature
'i /19 /I/Lo
Issuing Date Expiration Date
3G3c;

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 1) 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 (910-796-7215) 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/ 1-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 1 r 0,n txr �,P-
Date: %01C j / tc�
Permit #: 9 -�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
�,yh Ciro:.nd
Dredge ❑ Fill K Both ❑ Other ❑
�O + O(,ti ,��
(� , 0Cf-)
Dredge ❑ Fill ❑ Both ❑ Other ❑
lD s}
ddSC
Dredge ❑ Fill ❑ Both ® Other ❑
,3QCjl
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanaaement.net revised. 02/03M 0

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: r-o- 4-11 1C I-,, A (/-- C
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized OD ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: OU Ire 13, Z-kA v�
at my property located at lc- S L'A- Z �l
in e�i /Yy-- County.
I furthermore certify that 1 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:
Signature
i;wk Gt-�Vc
Print or Type Name
V� &2
Title
Date
This certification is valid through I /

I hereby certify that I own property adjacent to1-YJ 'ice S
r O filc � (Name of Property Owner)
property located at ('�
( ddress, Lot, Blo ,, Road, etc.)
on�
�'kDe V%A11 , in 4 ,��n o�L , 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 proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must M/ in escription below or attach a site drawing)
h \
UO/
<, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
A
(Property Owner Information)
Sign re
Print( rTyp fl)i Na41 me
n'
A4aihngAddress
Cify/Sfafe/Zip
Tel Number/ email address
I n( 1 9) 1 '-w� r %
Date
-Valid for one calendar year after signature*
Prop wner;�nformation)
1
Print or Type Name 1
M ' Ing Address
t T" � kA10
citylslate /p T ep ne Number/ em�ai` Qddr Ss
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f sw,V T Y q s
/ (Name of Property Owner)
property located at i
-t
ddress, LOU, 619� Road etc.)
on P��; �;,x`_ � ���t V'U , in :lI -D AN 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 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)
�n- bQ--1
CIE,
0
WAIVNI understand that a pier, dock, mooring piling,mp, breakwater, oathouse, 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.
(Property Owner Information) (Adjacent Propert� Owner Information)
Signa Mn 1 i
Print or Type Na C
'�6 'no xv ,
Mail/ Addre sC� C n
U at ; P � 2°10
Teleph ne umber/email address
(' i G'. n .-%1 C;
Date
;Valid for one calendar year after signature"
or
3.2
C.
sa &'
f it L — `l` // [i
6rl/
j- 0/
(Revised Aug. 2014)

. / Z-T��a
a
(RAjIgnat), N(GCCC, (Q)
im
k-J
f-i
IN-
L i Z
c
k
67-REIVI
andu ji e CIS Use7C= I
Ou pu 0, n -5 t me rent"k, Mra ? c, o n tt j- i W bu ms, a

tA�'

161
I L,h