86409A_Bugge, John & Anna_20211105

®CADREDGE & FILL NO 86409 B C D
GENERAL PERMIT Previous permit
f Date previous permit issued
® New N Modification ❑ Complete Reissue ❑ Partial Reissue
As audtortmd by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC R.I. attached, General Permit Rules avallable, at the folfowing link: www.dgq�Qov/CAMArules
Applicant Name 36lbi n &inn van_^R� V__ Authorized Aunt L, 5 n� ii i f e
Address 2171 T► A % Cj��� yg T n, y_ Project Location (County): _ _ e �1'YIQl�.4 r i/y MFg
Ctty _ 4.5: el state Street Addr'e<s/State Road/Lot
Phone #620)_isIr7 aM , �.. t
MZv Q �'M:�'!rit't .r t. CORM Sui division _ }lTa 'r srCJl ne�
71P _Q-79qA
_
Affected ❑ CW NEW X PTA ❑ ES EJ PTS Adj- Wtr. Body i`T (6Cgn r;r IP SCIAs.J (gJman/unk)
AEC(# ❑ OEA ❑ IRA ❑ UW ❑ SPIMA ❑ PM Closest Mal. Wtr. Body .)( Sus e, t,J
ORW: yes/(% PN14 yes, Ire
Type of Project/ Activity
(Qt r X 1 Z 1 loud+(,
xLI' pig- edl $`+et�(y' shv r ide
Shoreline length �� f �� _
�r.,M......._ _._
Access Length t.
Pier (dock) length
FixedPlatforms) n X I�j i _,_... . j i fi —it
i
Floating Platform(s)
Finger pier(c) + _'TT ; ---�--�--+\'! -'r -(- jt.
�0
Total Platform area
r
Groin length/# ' - �..'__� i _._.., _t__ {
r-n rt
t j t i e r ,� t--
eulkhead/ Riprap length
Avg distance offshore --- ' . :-f--.__' _ t x._ __ +' �:_j i
Breakwater/Sill 1. ..., _,_�.�,_,_.�. � ..�__---,-- � , -•r-
Max dlstanrr/ lengthZ
Basin, channel i
(Scale: ( j 1= qd)
b I
i ; 1
1 ' i
t
i •_t
Cubic yards ... -----(T._L. _..,— - ;-
Boat ramp
S k
Boathouse/ aatl (O xl2 r r i >—i- —�- _-I ; r -1 .. ` i f 7--•—a r�
Beach Bulldozing t -n--r- _-� _• �.;�_�_s ..,
OtherL_ i
SAV obscrved: yes
Moratorium: yes no40
qv
Q
71
Site Photos: no '. , + -i .� . s_ '-L i_
Riparian Waiver Attached: yes n� _ .».._ t ._ ' o_a .. !..."_� �. ._ ___ I i • _ -_ t ` . �__:
A building permit/zoning permit may be required by �CAf^l3 tit. s+C �ir..
i r�.. r s �� ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions l,i ��� t1n. �)Ltian �Zi` P,nL trncLn w,e,.}.
Y, cr[tr� �ZC t'�si Ca0.1___ _ ❑ See note on back regarding River Basin rules
`— ❑ See additional notes/conditions on back
LAM,
Agent or
Signature **Please read`complfance statement on back of permit—
Application Fee(s) Check #/Money Order
AND
STATEMENT (Please Initial)
01. l.
Permit a c 's PRINTED Name
h 1M
Signatur r
�l hz.
Issuing Date Expiration Date

Lyn Small Inc, Marine Construction
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _John Bugge,
Mailing Address: 237 Tranquility Lane, Hertford, NC 27944
Phone Number: 520 4811517
Email Address: [e-mail] _
I certify that I have authorized Lyn Small Inc
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 237 Tranquility Lane, Hertford
in Perquimans County.
l furthermore certify that / 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 I rmation:
ature
Mr
John Bugge
Print or Type Name
Title
11 / 5 / 2021
This certification is valid through 10 / 1 / 2021
Date
This certification is valid through 3 1 31_/_2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner: � ( _ [ _ter ? �i i2 (V' V r ] J('�Y r't�E`
Owner's email:' ,y� 'J(L ' Owner's Phone#: 2t - Z t.S I —
Agent's Name. Lyn Small Inc. Agent Phone#: [phone]
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions must be provided with this letter.
l DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank) �L
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: 6mvwe r'I a (L A otvi%
V r /
Mailing Address of ARPO: / l�',Ok-y, c: i Cy r C,, kAe �t :'y 4,'d
11 f/ l
ARPO's email: t �trt,Yt Y f �c ARPO s Phone#:
Date:tp,ii 2 % b( *waiver is valid for up to one year from ARPO's Signature"
Revised May 2021

U.S. Postal Service'"
CERTIFIED MAILD RECEIPT
Domestic Mail Only
ru rartified MPH Fee
nj
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0 Return tleceipt (havlpy) $
El Return P4cejpt (fifw4rw*4 S Po
flequlfed
Adult &gnatu.,a Restricted Wveu IS
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Extra vomS, els ��,h,�box&dl
[] Rt— R.,dpt (—dwpy) $
[D E1,%tUM Rw,.ipt $
M D Gerue, malt RewiotW Dewery $
E3 ElAdutt 6ioftrtum NqUiRd $
EjAdult 6ignatuw fle6tricted DeRvery
C3 Postage
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9'42 CARV09 HW'j
KINT HNKR, I NC 27964
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1-9-275-8777
27%410
Term 0. ow
Clerk 1). 000001
SALE
"I-11-11,010
AMEX Chp
TOTAL- $14.76
09/22121 10:58:35
Inv 4: 000002 Appr Code: 802045
Receot #: 00000617
M SAS final In Stam and Po 51
Alfunds for &liarantled Sortitg0
AMERICAN EXPRESS
AD A000000025010801
AC: 34 82 FC 91 61 139 F1 FC
CVR: SE 03 00
IAD: 06570103AOA002
TVR: 00 00 an Bo oo
TSI: E8 00
CUSTOMER Copy
01de Stow at usps.CoOlkop or CAR
AN-StanDR Go to
UPS toplehtinthip In print shipanp
ighth ith oo'lao, ro, alliff iffra, CAR
1-0111-AS6-Usps.

10/26/2021, 2:2$:00 PM
Address Points
perquimans_nc_misc
perquimans_nc_lot
Perquimans GIS
1:564
0 0 001 0.01 l
perquimans_nc_easement Imagery 2020 Blue: Blue
0 M1 0.01 0.02 km
perquirnans_nc_dims Red: Red �_�e Imagery2016 State of North Carolina DOTS±ale of North Carolina DOT. Esri,HEl
INCREMENT P, USCS. EPA
perquimans_nc_acres I
Green: Green
Perq
For tax purposes only Nol a legal documen± or survey Perquimans ncr State of NC assume any liability resulting from use

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11/112021, 3:32:34 PM
Address Points
perquimans nc_misc
perquimans __nc_lot
perquimans nc easement Imagery 2020
perquimans_nc_dims Red: Red
perquimans _nc_acres Green: Green
'Ok Sohr. d f A f\0,
1:564
0 0 0.01 0.01 M
Blue: Blue
0 0.01 0.01 0.02 km
magery2016 state of North Carolina DOT, State of North Carolina DOT, ESn. HERE, Gma arn.
INCRI MIN I P, USGS, f Ply
Perquimans C31S
f ro tax purpnses only Not a legal rfocurnent or srnvey Perqulmans nor State of NC assume any liability resulimg Inxn use of this map

Legend
Untitled Map '
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