78663A_Burns, Robert & Martha_20200522

• �ICAMA / DREDGE & FILL
1-1 "" .
GNEPERMIT
Previous permit#
ew Modification Complete Reissue ._-Partial Reissue Date previous permit issued
As authorized by the State of North Carolina. Department of Environmental Quality �l
R 111012-2
and the Coastal Resources Commission in an area of environmental concern pursuant
to I SA NCAC
soothed.
Applicant Name__`}
Project Location: County
Address_-
Street Address/ State Road/ Lot #(s) __j_.._ ..r�Gi✓+1
City._.....Knor s.___ /.arc---.---.._.,_.,. State i[G_ZIP �j
_._... __._- ..... _..-..______. _.___.____._
Phone #(711) E-Mail-?�!�s��c QI+o"'._c�^-
Subdivision- —--
Authorized Agent _ILO {.. f 1 kl�-fY_ ..__ . _ . -.
City��-..._4'1
C1M AW YIPTAES : PTS
i
Phone # (._^._) _ _ River Basin ...Q! rs- ..
Affected _ -
OEA HHF IH USA N/A
AEC s :
Adj. Wtr. Body �,(r �'� _. _. __ not man Junkp)
ORW: Yes / no-) PNA yes e-n;�
Closest Maj. Wtr. Body -C4ft4'`(c.
111 rpe of Project! Activity
._. (Scale: I �{ }
Pier(dock)length-
Fixed Platforms) -
Floating Platform(s) ..w _ l {� j� r 4 ( o
Finger pier(s)
Groin length
number
Bulkhead/ Rlprap length
M distance offshore
max distance offshore'___
Basin, channel
kltrg"'*'t
is _ --
cubic yards
i--
Bolt ramp
Boathouse/ BoatliR _-_...�.__.__
_. fill/4f
41 teed
A' ,y —1' .' y
of 1 3.� 32
of deak-
Beach Buildwing
Other. t,..ya
Shoreline Length
SAV: not sure yes
Moratorium: C� es no
Photos:
w tiS
c0�
ye no
Walver Attached: yes 0.
A building permit may be required by: Cc4t r" t'C-Ok
=-7
( Note Local Planning jurisdiction)
Notes/ Special Conditions
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AW*5 113A -W3­**V#1
jf
See note on back regarding River Basin rules. jj
Agen plkxnt 'nted Name Per gmitOffker'sPrinted Nam
le I
r- -Y �- - - --
14
Signor 4 Pleas ead compliance statement on back of permit" Signature
V4 oe We IQ ._.iG�..._�
Application Fee(s) Check # Issuing Date Expiration Date

Name of Property Owner Requesting Permit Wf� i�yrn
Mailing Address: j sx.
Phone Number: 7S--j— gO 2 - 20 r
Email Address: —_{0� ryl.S cal O c I -a lnn . C oh�t
1 certify that I have authorized
AUW / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development 105Lrntt A 154 4 (Ta
at my Property located at 1 L (�ec�Gt i_�, n �c+not k ss �Ar+c�PGt
in _ unr iiv Lk- County.
I fuithemrore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit oti9cer and their agents to enter
on the afotssmentloned lands in connection with evaluating information related to this
permit application.
Signature
Md�fzTN t�1 u Vt1 W�K'�1tl��iJ
Pant or Type Name
xOQu��
7ft
This certification is valid through _ J 3a 1 � 20

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN
I hereby certify that I own property adjacent to ot� kx O-V"'q5
Mot � s
-, j (Name of Property Owner)
property located at l L-�" - _ I
/ (Address, Lot, Block, Road, etc.) ,
on OrV ��tru:�l , in ki�0, 'T'56�r, 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)
r5
x ` 4 n`e✓
1
WAIVER SECTION I
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.)
N ( A- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
`ahem/ Owner Information)
S atu e
Print or T e Name
M fling A dress
G AGE_
CftylStatel&
S 2 -_ 2�7—r' i-Z
Telephone Number/email address
Date
(Adjacent Property Owner Information)
*Valid for one calendar year after signature* (Revised Aug. 2014)

-k)aynQ
AZA-k
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to a\n,4- a r A-5 s
1. (Nome of Property Owner)
property located at __ I �-_iwc �G�n -n 0
l (Address, Lot, Block, Road, etc.)
on in kne,�4c 1 c( �� N.C.
(WaterbodY) (Ctty/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)
1l0t I
Olt")
I Wlc��'�-�'1 s. ��r•� � �"� (�druwtA L4�+t
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.)
% ti I do wish to waive the 15' setback requirement.
N �} 1 do not wish to waive the 15' setback requirement.
it yiT ty vw1wr a -4�nnation)
si ture
Print or Type Name
f @ fe A�aa� f[c✓e a
/stag
�s�.-z��-�ZL
Telephone Number/email addma
Date _
(Adjacent Property Owner Information)
Print or Type Name
l7-5
. .., , 411 -A- r*J U J\& vL 1
Grty/5tate/Zrp
�✓ �S",2 y2�r_ f z33
Telephone Number/email address
`Valid for one calendar year after signature` (Revised Aug. 2014)
11'ttJll //

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