Burchette, James & Patricia 90005C

oN\°``°"�'"� �❑CAMA ❑ DREDGE & FILL N9 90005 A a c D
y = GENERAL PERMIT Previous permit
.,• Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
I SA NCAC i.- ""/ 's ? ;' +.%i ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Subdivision
City ZIP
ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
(Scale:
Access Length :---i--
Pier (dock) length
_
-
Fixed Platform(s) l
`
v
i
Floating Platform(s)
Finger pier(s)
M1
F -1
-.- ... _..
.
.
._..._...
...
_.......
Total Platform area
-
3
Groin length/#,.
Bulkhead/ Riprap length
��
'
`
t
distance
�y
-
-
Avg offshore
Breakwater/Sill
44--r
3
Max distance/ length
Basin, channel
jr
1#
Cubic yards i
- ,,•
,
Boat ramp
—
Boathouse/ Boatlift 1
Beach Bulldozing
i
Other
i� r
SAV observed: yes no '
Moratorium: n/a yes no
__
.. _...
�..
—
—
--
r• •._...
..
-
--
-
C
s.-
Site Photos: yes no -
-
i-..
- . -
—
)
_ ,
L._
...
.....__
.... _
Riparian Waiver Attached: yes no
r
A building permit/zoning permit maybe required by:
t
Permit Conditions 1,
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date
Expiration Date

*°``°`Sr"1& ❑ CAMA ❑ DREDGE & FILL N9 90005 A B C D
0
2 = GENERAL PERMIT Previous permit
Ja F1 Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC "` V 1 11 t (` ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
Affected 1-1 CW El EW
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
(Scale:: '-4: )
a
Access Length
—
_
_
_
I
__
_
_
_
__
._
--
—
..._--..
Pier (dock) length
_
I
Fixed Platform(s)
-
w
)—
i
Floating Platform(s)
''
Finger pier(s)
i .
'f
Total Platform area
Groin length/#
x
-
Bulkhead Ri ra length
C�
--
Avg distance offshore
.
Breakwater/Sill
Max distance/ length
t�
TP
Basin, channel�J
Cubic yards
Boat ramp
Boathouse/ Boatliftn
_ i
-
Beach Bulldozing
I
`.
Other
a
3
1
--
SAV observed: yes no
Moratorium: n/a yes no
o
n,
lt^j<
xt:
nx
-3
Y
EE
Site Photos:-
--
-
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
! _ l
i ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

COASTALN.C. DIVISION OF
► •
(Top portion to be completed by owner or their agent)
Name of Property
Address of Property: i
Mailing Address of Owner
Owner's email:
Agent's Name:
Agent's Email:
�,170VU
Phone# .
Agent Phone#
1 hereby certify that I overt property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached thawing, the development they are proposing. A
description or dravain with drrrwnsio€ s q t be pmvdgd with this tettc;
l DO NOT have objections to this proposal. I DO have objections to this proposal,
WAIVER SECTION
i understand that any pfoposed pier, dam, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a roinimurn distance of 15' from my area of riparian access unless waivcA by me
(this does not apply to bulkheads or riprap revetments). (it you lavish to waive the setback, you must �.,_sin
the appropriate blank below.)
100 wish to waive some/all of the 15' setback
S�ratr�re o/ 1� f FZiraY�r7 rt Fto
-GR-
I ado not wish to waive the 15' setback requirement (initial the blank)
Signatures of Adjacent Riparian Property Owner
TypedlPrinted name of ARPU:
Mailing Address of ARPO: - 1. DO-0 �'1
A 2PO's email: ARPO's Phone#;. - �° "' >?
Date: *- °waiver is valid for up to one year from ARPQ's Signature*
ature*
Revised July 44021

N,G. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATI Ni AIVER FORM
CERTIFIE i MAiL, RETUR 4 R GEiPT REQVESTED err NAND- -DELIVERY
Neap portion to be completed by owner or their agent)
p
Nam of PropertyOwner:
wner:
Address of Profaerty� lLll a f 1 i
Mailing Address of Owner.
Owner's email, fNI t't l g Owner's Phone*_ � w ( ' 91
Agent's Name- � Agent 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 for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
des- at€t a- or drawinet with dimensions must be provided with thrs}et[er.
i DO NOT have objections to this proposal I DO have objections to this proposal.
It you have objections to what is being proposed,, you must notify the NC. Division of Coastal
Management t`DChQ in writing within 10 days of receipt of this notice. Correspondence should be
marled to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
art [phone]. No response is considered the same as no objection if you have been notified by
Certified rail.
WAIVER SECTION
l understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
cgrovi mast be set back a minimum distance of 15' from 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 sor all of the 15' set ck s4.
S.W of Adjacent Arian R-operty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Properly Owner.
Typed/Printed name of ARPO: t � 3 Otis
Mailing Address of ARP©:
ARPO's email: ARPO's Phone#t
Date. *waiver is valid for up to one year from ARPO's Signature"
Revised ,1tdy 2021

8:12 PM Mon Jan 9
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