52579D - Burgun

CAMA / DREDGE & FILL
v'ENERAL PERMIT Previous permit#
'New --Modification _-Complete Reissue 7-Tartial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �/`� . /2g!/
E6Ades attached.
Name trf�i d 69yL,¢ �42� Project Location: County�2s/.✓sby��%
36 310 /1 AO Street Address/ State Road/ Lot #(s) / % 5 !O C,�q
y 4017 -e State WC ZIP .2.FyJQ L.Ar �� ' � -S _
(LIP ) Fax # ( ) Subdivision ��Jl/& 5�79 4(0�0�P
W Agent I-A24A y �yu l� City-5131-9-1I6- P ZIP 2
❑ CW FIEW —,PTA ±ES PTS Phone # ( ) //,, River Basin LNG,
❑ OEA ❑ HHF ❑' IH ❑ UBA N/A Adj. Wtr. Body Z-i77 to S/�y /l iyr �y (ni�/rr
❑ PWS: ❑ FC:
res� no PNA ,yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body ��W�✓
Project/ Activity a �,P f f i 2 cr [� P L PV � 2 p 0 ,� p� f L,4 711" ,
(Scale:l
k) length 92 ,� v
gth
fiber
/ Riprap length_
distance offshore
c distance offshore
►nnel
is yards_
P
e/ Boatlift
Ildozing
Length 2 5V
not sure yes C 0
not sure yes &
im: n/a yes (W i �y i I
I yes c; - ( .. . - C✓E
i
cached?+es`. no__ /
g permit may be required by: T/Z p , 5, /,c C'Gs. Y4i ❑See note on back regarding River Basin rul
ipecialConditions 57kOc74,,( r M"Jr 6-P rlippzIPW x ov,^ . a,'O � f��O[�L ,Sti4511 ele
n

ALT4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date go — 0
Name of Property Owner Applying for Permit:
Mailing Address:
":�(3
I certify that I have authorized (agent) Lac(IA410,41(- tt.412 ()mto act on my
behalf, for the purpose of applying for and obtaining al CAMA Permits necessary to
install or construct (activity) (jpu) R e r ,
at (my property located at)
This certification is valid thru (date)
911:50/0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHO USE)
I hereby certify that I own property adjacent to ?Ay Pr d 66�- j BU Q-GUA) IS
(Name of Property Owner)
property located at 17170 L Nn a ccz Lea �a�ti4 _ w; 6 , P, <t r 35l/4, ,
(Lot, Block, Road, etc.)
on L ( T m S ML-4 L1,0 n-e' 2wc rL , in in � �a �s rt -f(= / i.�ti s�+�'c�- , N.C.
(Waterbody) "(Town and/or County)
Applicant's phone It: 9/0 - -2-SV— gt 41U
Mailing Address: 3 (.3 y >�-'o
s�I,60 ,& r- 99'1/7,-�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORINGPILINGSIBOATLIFTBOAT.NOUSE)
I hereby certify that I own property adjacent to PAU -A f �� f31it2GuN 's
(Name of Property Owner)
property located at cde I -A -D I tiC, Lai � � P ,� 4---T
(Lot, Block, Road, etc)
on L,-rn in-&-ma-f�s,anw�� �r��Js,�,�u� ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 9A-2-) s��- lG u Mailing Address: -?&31(
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pierlmooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature

ATLANTIC MARINE CONSTRUCTION
P O Box 713
Shallotte, NC 28459
Ph 910-754-4247
OF
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.eom np ✓a Z)
C
DATE
FOR _
cr P v12,�r L.,-,- (�v
11600000.G30 is 5 3 L L 2 L1:000 5 2 9 5000�i—
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