80223D - Gussenhoven

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eCAMA/ DREDGE & FILL ( Isc&' s ) No 80223 A B ei
GENE_ RAL PERMIT �.--^.- Previous permit #
..;New . Modification Complete Reissue r Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 1 ii. • a 500 .
-n � 1 9Rules attached.
Applicant Name TOvrfo,v C LA-S �11,1�UN�\/C Project Location: County IQ tHU V Ofiltr
Address ...1-S \t r u 1(-4. by tV t. Street Address/State Road/Lot #(s) 4 14_ t W`wu N
City =--(s. L Gk fly State N L ZIP ? {1J uce*
Phone # ( ) E-Mail j ov 4G•V103uSS Q 3i0Y‘A k 11001 Subdivision i- ,. 61+t v L 16, l S. (a`—
Authorized Agent of tp 1>,pp,VI City") k\Ylkt‘.'(l"ta^ ZIP ?-?1-4-0
❑CW ®EW 1 PTA ❑ES ❑PTS Phone # ( ) River Basin \N V\ l G V...
Affected ❑OEA ❑HHF ❑1H ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body/nG r ✓h G c bGS 1►,1 (nat /man /unj)
❑ Pws: V\-A ''lC «9 Saul-cj '. S l�
ORW: 0/ no PNA yes no Closest Maj.Wtr. Body ` rC.1nc
kitLa
aTy e of Project/Activityi. t� U o v\ ' naLt i 1V X -�I. j -
c1oc ��\r��TDv YY' dG VNGc�CC� 11n V V CG VLF ZSa«; • (Scale
• ,/, 70 )
Pier(dock)length
J l� 1 I 1
Fixed Platforms I t i
Floating Platform(s)se X a 44 ' 1 r '
i iIN 1
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1� �'V i I
Finger pier(s) A 1 .'._... • It.' l..r�� I
Groin length / IHII!!
N- lillinii0
Bulkhead/Riprap length IN >I.^' ^ . ■■■■■:■■■=:
avg distance offshore
tUhIIIlILiIIIIIIlIIl HIIHIIIIII
Basincu Wel
HHhIHHIIHIHHHU 1 I I IHHHHI
yards ■■■■■■■■■I■ l F■iE■ ■■■■__ : ■■■■■■■■■■■
Boat ramp HHHIHI 1 I 1 IRWEllel..... I _..iimiri
Boathouse/Boatlift II
E ...Emma il■■ ■■■■I ? i I ■■■■■■■ J : ■■ ■■ ■
Beach Bulldozing ■■■■■1■■■■I■1■rPPES■■■■■■■u■■ ■■■■■■■■
Other ; t
1
Ol j 11111111111
' .1111111111E1111 ■ ■■■■ ni1L�1L'�■�■■■Shoreline Length I ■■■■■■■■MMITMEi O■■■
SAv: not sure yes ■pa�MM����MM�Ny��aM1�r�a�77��1•��-1— ==�•1���1��
r ._. _ ■■■■■■■��, M.MgR2 1110■■■■ ` ■■■■■■E■■2 •
Moratorium: n/a yes jL•7 4 r 1 ._ •I 4����IG� icx.r : :�■. t ■■■ _■■■■t_ I iPhotos: yes __ ._.._ J_.._ I _.I N ■ ��■■ I ■ 111
i...
Waiver Attached: yes ,
A building permit may be required by:1--
' AV Q E\ 5 ftlA P See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction) J (
Notes/Special Conditions , S1)CA\ I S- .k G -t L`U'fn ' v1i..1t A k`^,
4a4 hckv1VLL C.lk\-'
Agent or Applicant Printed Name PermitOfficer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
-; /) 31-1 --il 3 i> I
Application Fee(s) Check# Issuing Date Expiration Date

r
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 I)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 (252-946-648 I) or the
Wilmington Regional Office(910-796-72 15)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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare, Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

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Elks, Katharine B
From: trip pippinmarine.com <[e-mail]>
Sent: Tuesday, March 16, 2021 11:19 AM
To: Elks, Katharine B
Subject: [External] 4 Skimmer
Attachments: 4 Skimmer Pt.pdf
unless you a suspicious
,fZe a Or3t
Katharine,
Attached are the signed forms for 4 Skimmer.The floating dock was lost in the last hurricane.At this time I'm just
installing a new 8 x 24 float to get by with a general permit. I'll apply later for a major to put a 6 x 16
I-shaped dock at the end of the 8 x 24.
Trip Pippin
Pippin Marine Construction
E-mail:[e-mail]
Phone: [phone]
1

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ERTIFIED MAIL • RETURN RECEIPT RE ESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: )--dtzeft247 64,i 4 ell/ J"./
ept
Address of Property: I '
(Lot or Street#,Street or Road,City&County)
Agent's Name#: /1Y ^ ..j /{,/ Mailing Address: . • e Q' 1/21/
Agent's phone#: f 61 - dti " .2)07V 44i 11 04 /Y+( z c [
I hereby certify that I own property adjacent to the above referenced prop+ L r ak .)
applying for this permit has described to me as shown on the attached drawn
they are proposing. A description or drawing,with dimensions, must be provi
• ScJ
/ I have no objections to this proposal. I have objections t
If you have objections to what Is being proposed you must notify the Division o
(DCM) in writing within 10 days of receipt of this notice. Contact informab
available at http://www.nccoastalmanagementnet'web/gmistatf-tlstinq or by calling z-w..-.•.
No response Is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse,or lift 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.
(Propefipmner Information) (Riparian Property Owner Information)
1,170, l\A_40LOC2A.
Signature Si:' ari ' �
W. Jordan Gussenhoyyn .,t l`� ,`40 t I
Print or Type Name Print or Type Name c
2519 Wake Drive (1 LfQ &L y{ v,1 'L2-) '
Mailing Address Mailing Address
Raleigh, NC 27608 6 (.- , UT t C q k-
City/State/Zip City/State/Zip
[e-mail] 9 Ic `LD I c)--I f V D
Telephone Number/Email Address Telephone Number/Email Address
V8I2i 3-1 1 j ail_
Date (Revised Aug. 2014)

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CtittiAtatitAIL. RETURNi.RECEIPT.REQUESTED
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N.C. DIVISION OF COASTAL mANAppywNT
AGENT AUTHORRATIOR FORM.
Date
Name ofProperty-OvynerApplying:fOrT,ertn*
-6,isdapt 144
Ntailiiig,A.ddi6sk:
$04N,Lle
16 022-6-4-a
certify that I haVenuthimiZed;(agent), ri>; 0490 to actottny
behalf,for the,porpoaeof applying for and obtaining all CAMA Permits necessary to; ;
mstall or construct(activity) et? e.dzif.144., ,ft?ekfil!E •i ,
at(my litopertykicated at); AV: A.0(t, .
ThirtineAtion ilia thrit tditte):
2/8/2'
,,
.PrOpertjr3Ntner Signature Date
•
•