78010A_Burgess, Ruth Ann_20210208

�� CAMA / )(DREDGE & FILL IN77
B C D
GENERAL PERMIT Previous permit #
XNew Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina. Department of Environmental Quality �-{�t�-,
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC T a''i_n ot)
Rules attached.
Applicant Name Ri.l:t Yt- Avirl Project Location: County ('t7 ►'Kr ,t/�
Address r-C . 0(`A 131 i 1 2G1 6h�; t, Ni k,., Street Address/ State Road/ Lot #(s) j 'a- I 5c f� D 11
City '4jiV1 1 4 k,•.. _ _ _ State NC, ZIP 2 1 ` f"
Phone # (Z62.) 489 — rig4-J E-Mail _
Authorized Agent pt: y } t
Affected CW *(EW '(PTA ES XPTS
AEC(s): OEA HHF !H UBA N/A
PWS:
ORW: yes / no PNA yes / (q
Subdivision ` ----
City -�-Pvx' t..ok ZIP ;2—f`114
Phone # ( ) River Basin flw�qucit�
Adj. Wtr. Body �'2'lf tit' GG✓L�-- jVeV �s�man /unkn)
Closest Maj. Wtr. Body � 4k� !°-'f 4 {ct,Ct1 l vc,4''
Type of Project/ Activity Ua ) z 14 !' �"' a I( �T �It t-V "Al - t l 30 a-7 Grp
12c �4-1 C0 ' Lk-,204 ee i..Lile ALL � (�x [� �� � a vJ,'E.�i� yv��rr� (Scale:
Pi�
Pier (dock) length 1
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)15
�)
Groin length },T 9 fj
number ? `y cr�i NT "9 a 0 ItV
praplength.�avg distance offshore} q max distance offshoreA-Basin, channel p ��v �i3cubic yards �• � _ j e%ty�Y1Boat ramp — �t {
Boathturse- Boadift
Beach Bulldozing
Other
Shoreline Length
SAV" not sure yes
(_�4tlrlh_i(,V
Moratorium: nJa yes no es O
`,� ,p"'
Photos: no �oi } ye,"
Waiver Attached: yes Ile)
A building permit may be required by: See note on back regarding River Basin rules,
( Note Local Planning jurisdiction)
Notes/ Special Conditions
and Narne
Signature `"` Please read compliance statement on back of permit
Application Feels) Check #
Permit Officer's Printed Name
Signature 644�
,1-1 b11091
Issuing Date'
(�8J2,02_
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATMECEIVED
J A N 2 5 2021
Name of Property Owner Requesting Permit: &)N Lvasc55
Mailing Address: 1 -2ck S ��C71Z OGL1 tr
5-�A((-C* 0(�_
Phone Number: Z s Z- Q-A �- 9- -S 9 1
Email Address:
I certify that I have authorized PAS C)LYr_--T-T- ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at f -2- Ct n b DrR c- )02.kq L SIAl LO 1-A
in C� M Di✓ Jul County.
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
r.
Signature " — Q
hlz'rrcvLj
Print or Type Name
C 0tjC0-
Title
/)�) / 2
Date
This certification is valid through S /1 *5 1 Z _

&off 52 ?a -It 3 t q
an r. ewmerwe
...raw.....
MOM CAROrwNA
CAMD® COUNTY
DR" Bf s
JDRN T. CHAPPII
ATTCR101T' AT LAW
THIS DEC% Made this 26th day of April, 1968, by John R. McDonald and
rife, Dorothy McDonald, of Perquimans County, North Carolim, peruse of the
D.
first part, t..Despsey / Burgess and rife, Ruth Ann Burgess, of Camden County,
Worth Carclim, parties of the se: rand part:
W I T N E S S E T H
That the said parties of the first part, for and In :onsideration of Ten
Dollars and other valuable cone ulerations, to them paid by the said parties
of the second ;art, the receipt of which is hereby acknowledged, have bar-
gained and sold, and by those presents do !rant, bargain, sell and c.m y to
the said parties of the second part, their heirs and assigns, that certain
tract or parcel of land in Shiloh Township, Camden County, North Carolina,
bounded and described as follows:
Bounded on the Northwest, Northeast and Southeast by the property
of W. J. Overman and (11eorgo J. Winalcw (formerly A. C. Garrett){ on
the South and Soutl.weet by the Paoquotank River; beginning at the
U.S.Q. a Geod. S.u•vcy Monument aeur the edge of the Pasquoueudr
River, thence 44j- Fast 396 fast; thence South 5 a East e7 feet;
t!..•r. %-th Zoe tr' F)w t 1.1 fertt thence South 5f 3/4e Bact
feet; thence South 27' West to the edge of the Pasguatank River;
thence kr,Gmrdly, :•outhwestwardly and Northreatwardly along the
who" of laequotank River to the point of beginning, the foregoing
tract beds( part of the tract dsnalnated ^C. L. Wiwwerr on the
map prepu•ed by Rueaell E. Snowden aid bearing the rotation "sur-
veyed August 15, 1944, and April 6, 1945,e reference to which is
hereby made town a more complete description, said map being re-
corded in Plat Book 1, page 2, in the Public Registry of Camden
County and the sa:d map ie hereby incorporated in and made a part
Of this dead; the tract herein conveyed being delineated on the
aforesaid sap in brown ink, together with all riparian rights,
rights of entry and rights to lend under water appurtenant to the
tract herein conveyed. The foregoing treat being a portion of the
tract conveyed to C. L. Millar by dead recorded in Rook 25, page 597
in the Public Registry of Camden County. This being the same tract
that was conveyed to Oscar S. Willies and vile by C. L. Miller
Mid wife by deed dated March 15, 1946. and recorded in Book 27,
page 493 in the Public Registry of Camden Cowty. Being the name
tract that was conveyed to John R. McDonald and We by Oscar S.
Williams and wife by deed dated July 14, 1961, and recorded in
Book 40, page 39U of the Public Registry of Carden County.
Also conveyed heroin is the easement for right-of-way to pass and
"Pass on the street that leads from John R. McDonald and wife
PrOPerty (formerly Oscar Williams property) to Milltown Road in
accordance with " agreement recorded in Book 27, page 517 in the
Public Registry of Camden County.
TO IAYg AND TO HOLD the a.ceamid tract or pamal of land, and all priv-
ileges and appurtenances thereto belmWing, to the said partiea of the second
accovdUn. i0 -""-
I recovds
311
N
�w L__ ---

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT RECEIVE[
I hereby certify that I own property adjacent to
property located at
TH AQ!J 's
(Name of Property Owner) 1qN 2 § 2021
Address, Lot,
on �t asQ UOTAl•.1 e- Vt� -'L , in
(Waterbody)
(City/Town and/or County)
CM -EC
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)
/3o (:
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back inimum distance of 15' from my area of riparian access unless waived by
me. (If you w" to waive the setback, you must initial the appropriate blank below.)
2I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner In mation
I't 4�m
a re
s(� ,� 2 55
Print or Type Name
I Zq S Hoky-� ©I
Mailing Address
.::�" i („ o l-A N C.
t yy/State/Zip 25 Z — \-f S6
Telephone Number / email address
Dale
(Adjacent P perty O r 7tion)
z , Z
✓'kn l lure *
Print or Type me
Z � S ? `Oi-f �� Nr
Mailing Addiess
6 <t,10 7 -,f/t"
City/State/Zip
:? E2 (v/9' 37e
Telephone Numb r / email address
/ %7-�
(Revised Aug. 2014)
"Valid for one calendar year after signature"
PPKI,
AO

129 Shore Drive, Shiloh
January 7, 2021
Streets Addresses
Streets Parcels
Main Roads ® County Boundary
1:826
0 0.005 0.01 0,02 mi
0 0.01 0.02 0.04 km
Source: Esn, Maxar, GeoEye, Earthstar Geographics, CNES/Airbus DS, USDA
USGS, AeroGRID, IGN, and the GIS User Community
Esr( HERE, Garmin, (c) Open StreetMap contributors, and the GIS user
community
2021

;1
4
IK
Ai
r
.� '.;,�� fir �: � •� ,:". � � - b � %' '�
R. I' � / y T ♦ �'� 5 .
` �S,�L �Cr t s: s t- a . M ) �,'g�t,., �' �• Y .w' - ` ,d t`�4, ��
sR�':•
a. L
i
�9 1 ,,��,,,ra fir' F 5 lY 4 • � � � � � _ .� -
- !fie `{, rF ; . � � �+P F I ;ti• a f;. � 50,
J Vy4 i JT i