55821D - Burgess

'LAMA /--rDREDGE & FILL NO
i�NERAL PERMIT Previous permit#
New [.]Modification L1Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources I/
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC //' % l 0,9 1 Z,0v
L [Lifts attached.
// Name 51) N 2cl •z & .o SJ Project Location: County ���,v� w�c�
l 3d & Street Address/ State Road/ Lot #(s) h,4
a ,e.7Yd„fQ
State ZIP 2 F-TO.5--
4/L5'-276/_Oax#( )
sd Agent
1. �A2 L -1S 1n44 ve .4
- CW
[�fV C-�PTA LI ES ❑ PTS
❑ OEA
❑ HHF ❑ IH C UBA ❑ N/A
PWS:
❑ FC:
ees
PNA yes Crit.Hab. yes / no
Subdivision
City %1OL(t v-' 4s-e4ch ZIP .2 F Z/G
Phone # ( ) River Basin L11,74
Adj. Wtr. Body CA A 1 of K J�7/ ZVka (natt n
Closest Maj. Wtr. Body. /� k A" A/
Project/ Activity A e t-✓ eh -gg a/
(Scale:
:k) length
(s) �X
er(s)
igth
nber
Aiprap length
distance offshore
x distance offshore
annel
iic yards
ip
se/ Boatlift
Aldozing
rArftItr <L•R
Length S-o
not sure yes CO .
>. not sure yes
iurn: n/a yes Cq7
j6i ,no
\ttached: yes 4S)
ig permit may be required by: 11QL(lON J "'9 L-1 See note on back regarding River Basin n

Canal
8'
P L
Existing Dock
228 Sq'
i
12'
Proposed Pier
' Replacement, 1 ,
144 Sq'
roposed vinyl wall
�Tr
Existing wood wall.

47 �:T
NCDE ` R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue James H. Gregson Dee Fref
Jovernor Director Sect
AGENT AUTHORIZATION FORM
ate: 0
ame of Property Owner Applying for Permit:
failing Address:
'hone Number: (P -) ZM_ I �7-------- —
certify that I have authorized (agent) ty'S �/�__�J to act on my
►ehalf, for the purp
;onstruct (activity)
it (my property loc
This certification is valid thru (date) �%
I /I/-
/ 0,011tf -

► -- zws~
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own propertyadjacent to li`, �°.cS.S is
(:dame of Pro rty Owner)
property located at D
117
T
(Lot, Block, Road, etc.) on Cv�a,� , iny61JeA--6" , N.C.
(Waterbody) (Town and/or County)
Applicant's phone f# l� �� Mailing Address: ID%owit, v�4
e
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
Awl Addre
/�w#�� ` r, AICZ�3as
(Riparian Property Owner Information)
Signature
j

►I-lws~
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property- adjacent to T6 I&
e u 's
(Name of Pro rty Owner)
property located at 117 AM- 6M, SY—
(Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:(fp) [,k1,r-Aa
Mailing Address: Tim I s
Eve
(/ Q
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
t
Sc X�a4�jOi��,,y
(Information for Property Owner Applying
for Permit)
mS
Mailing Addre
li;x ye, /IBC aS os
(Riparian Property Own Information)
—07
Signature

plicant: cJ,d
te:
Permit #: > -
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
and in your Habitat code sheet.
bitat 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 fin
disturbance.
Excludes any
restoration and
temp impact
amount)
S L
Dredge ❑ Fil�VA Both ❑ Other ❑
SQ
Sa
f�
Dredge ❑ Fill ❑ Both ❑ Othery
Q (�i
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 ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

Mareene Construction
P. O. Box 370
Supply, NC 28462 66-112/!
DATE
PAY
TO THE
ORDER OF —K
u`l DOLLARS
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BST BBT.com
FOR &P 55SO'M -and-
1130000 1 L 54111 1:0 S 3 1 C) 1 1 2 11: 000 S LO t. 2 13 3 1 a ij-