47441D - Burns

❑LAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name
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Address
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City
State ZIP
Phone #
-Fax # ( )
Authorized Agent
CZ r>
Affected ❑ CW KW
IPpTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no PNA
yes / no`, Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length _
Platform(s)
Finger pier(s) I �;
Groin length
number - - j
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards _—-
Boat ramp
Boathouse/ Boatlift
--- .— l i
Beach Bulldozing _
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no EL
Waiver Attached: yes no -
A building permit may be required by:
Notes/ Special Conditions
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regarding
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River Basin rules.
❑ See note
on
back
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit"
Permit Officer's Signature
Issuing Date Expiration Date
ApplicationFee(s) Check# Local PlanningJurisdiction Rover File Name

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 Quality. Contact the Division of Water Quality 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
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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 -below New River Inlet- and
Pender Counties)
Revised 06/29/OS

/45
LAMA/ ❑DREDGE & FILL
iENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina,Department of Environment and Natural Resources -
pasta!Resources Commission in an area of environmental concern pursuant to I 5A NCAC 1 • \ )
Rules attached.
Name 1.-- (..: l-t-- \31 g1 CL-ts)S Project Location: County ?i iJ70 i-_
L- 1 0�.:E. 5 -�E., 1,-) W Street Address/State Road/Lot#(s)
-4..\_,�= Z(xt-j ,J Statel\) 6. ZIP 1_71(0 7-L ) 0 1 C-iA,L.:).L-s'n)fr\ 6 t_v"t-
(f t,\<b- Q,\c2.Fax#( ) Subdivision
V l..t..LQt^> City JP'S6�i L- 13CYaC�-\ ZIP �y 4
:d Agent ��
❑CW EW )TA (
❑ES ❑PTS Phone# ( ) River Basin�-r►i)C:
❑OEA ❑HHF ❑IH El UBA ❑N/A Adj.Wtr. Body 15141 VL-1 LA to J 6 / /n
❑PWS: ❑FC:
yes /fyi. PNA yes / no Crit.Hab. yes / no
Closest Maj.Wtr. Body /0'.)51. 'Et Cot^
Project/Activity ✓~:)C-p;{. .-_ ;, ICI,,:)on'EL, '.) I NS'r_AL..4_ S , )..),,Dj2 T (r J7 1 mot:
X.&tv--- , 1� y X L� S t G?7�N j=;��r�- �x»�2 e�� t't.r�F�a�tcale: ,,
ck)length ,
O �
i s L- -1
-
ier(s) -r- n , • I I
'
ngth ____,OlaWemossomm :
III ell 0.
r�
mber j
F-
d/Riprap length *
g distance offshore t 1
ix distance offshore ... '_ 1.... --._ ....-.._._
hannel
bic yards i ...
nip 1 �_. }
use/Boadift I
3ulldozing
► ;L L tom' I, 111011101=11
T — —_...—.
n1. oi2.," N G l .
r.-. i-.. \ _ _
ne Length _
not sure yes no
gs: not sure yes no —
>rium: n/a yes no I � f.
-- - r-
yes no t 4-I ._l -,- +.. -
•Attached: yes no '

T.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ael F.Easley,Governor Charles S.Jones,Director William G.Ross Jr.,Se
Authorized Agent Consent Agreement
loll; //u- ,
is hereby authorized to act on my beh2
(Printed Name of Agent)
er to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to
fic activities described in the attached sketch.
'TION OF PROJECT: rr
1 o ( CiARdiew hke .
•
tp / LAekf ,,i/L
oZ�y /s
'ERTY OWNER MAILING ADDRESS:
)I �juf n.1.)
6 y01 Darin 1n
D761,Z PHONE NO. 7/ *-- d Sr/ - $ 7s
ORIZED AGENT MAILING ADDRESS:
JQa4487 �, 05 ley i v c,
qa 1444111
1/4,1/s it& a g4/48
PHONE NO. /�� c)3 - 0)330
ture of Property Owner.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: D41J B
6-1r43
Address of Property: CGy o)(fiei ,B)ya/
(Lot or Street#, Street or Road)
l ty4) 64t iertk{-
.
(City'and County)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described tome as shown on the attached drawing the development tt
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house or boat lift must
set bck a minimum distance of 15'from my area of riparian access-unless waived by me.
you wish to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
C----)d .
I do not wish to waive the 15' setback requirement.
`411111111teer 41/i
/ .., /e1
Sign Nam:, • Date
. -- doh n ��/C� elc -';,'A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: Pell - -
Address of Property: /oi O (y'a 1 f
(Lot or Street#, Street or Road)
Penclar
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individi
applying for this permit has described to me as shown on the attached drawing the development th
are proposing. A description or drawing,with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasi
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock, mooring pilings, breakwater, boat house or boat lift must
set bck a minimum distance of 15'from my area of riparian access-unless waived by me.
you wish to waive the setback,you must initial the appropriate blank below.)
6r I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
z Z (o
Sign Name Date
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