89083A - Burgos, Ray and Pam

tscm14, OCAMA ❑ DREDGE & FILL NU 89083 A B C D
. GENERAL PERMIT Previous permit
s 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 Rules attached. L.1 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name <nJ ` )Jn.-, f�iura Authorized Agent
Address - S:' (I Project Location (County):
City (l State ZIP Street Address/State Road/Lot#(s)
Phone # (� )
Email 1=aSubdivision
City Sr ZIP
Affected ❑ CW [11 EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr, Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes ;- PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
i
Floating Platform(s)
Finger pier(s)
Total Platform area `,.al% \ t
r
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no ) , , 4Vt
Site Photos: yes no tr f c — Riparian Waiver Attached: yes no t _.'_-
A building permit/zoning permit may be required by: 1, rYx
Permit Conditions
(Scale: IV )
❑ 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 Feels) Check #/Money Order
Signature
Issuing Date
xpiration Date

r
! 1
S I +
ej
I
I
_
Qj
fo
I
I
�i1
R 1"l
lT ` .- w.. �. rrb
I I
111
--
W, rl- j I
!-
_
+ I �

............. .
/�� vU/ <-,i.,...✓ 1/.,�.. Ain _/ 1 _ 1 •�.
g�ri? eVmCdoaat..gE
ccr�c�e.t �
r? =dry AWt ! am mOmlodb gwA and do in fid grantlwaaile*" [o
co me
aiF�e►� >rhr�ioaat�lto�ceraad
ire it
.f
tr,

ADJ
Gi
Name of Profs
Address of Prc
Mailing Addres
0,vner's email'
Agent's Name:
Akjonl's [mail:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom tsortlon to c mole d h Ad' ce
—L�-�_L y._.�,�a,,,,,{S PL4party Owner}
t hereby certify that I own property adjacent to the above reterer>tx;ri Prot>nrty. The individual app}ying for this
Permit has described to me, as shown off the attached drawing, the devolopntonl they are proposing, 9
dxr or drawln
cZim@nsions. mnar na ...:_ ._.. _.
00 NOT have objections to this proposal_
._-_q--_ 100 have objections to this proposal
n you have objecttoaa to what is btri y -'"" �T - -- - — -----
9 proposed you must natNy the N.C. Oivlslon of Coastal
Manergement (OGM) to writing within 10 days of receipt of this node&. Correspondence should be
malted to 401 S. GnVn St., Ste..100, Elizabeth City, NC, 27M. DCM represontativos can also be
contacted at [phone]. No response is considered the Sarno as no objection If you have been
notified by CorMed Melt.
WAIVER SECTION
I understand that any proposed pier, dock, meeting pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my arena of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments), (If you wish to waive the setback, you mu 1 n
the appropriate blank below.)
100 wish to waive some/all of the 15, setback
Signature o/Adjacent itiparian Property Owner
Im
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian f
TYped/Printed name of ARPO:
Malling Address of ARPO:
'7`c7y
,wvr.
ARPO's ernall: � ��.' ARPO's Pnonetk a 3a %4 --06 t )
pate: r Zt> 03 wvalva+is valid for up to one year from ARPO's Signature*
Revised Juty 2021

0
�I
N.C. DIVISION OF COASTAL MANAGEMENT
A0- D MA�.._ I� ' RETURN RECEIPT RE OWNER N ET EDAor HAND DELIVERY
RM
(Top ortion
Nxrs to be cornpleted by Owner or their agent)
°! Pic'{"' ---- —.
p�,i:essapropem
Mad+*J
p0611 of owner:
00"(5 email: rSPhOtno#:�
A.°ts Name: �L4� � � � Agent Phorw#:-254, 3, 1—l�_
nr'sEmail: Q e✓i
ADJACENT RIPARIAN PROPERTY OWNER g CERTIFICATION
(aottom portion to 4e comateted by the 4dlacent Proaa, fff)
I trereby 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, tha dev
dasmp n_ rawina, w th dimen._s(on must bo pravi—_dam with is letter. ant they are proposing. 4
_ !: _ I DO NOT have objections to this proposal_ ,� 1
__ DO have Objections to this proposal,
)) yov have objections to whet Is be/ng proposed, you must nosu ft tiro N.C. Ofvfston of Coastal
maileManagement (OCM) In writing within 10 days of race/pt of this notice. Correspondence should he
mailed to 401 S. GrUyn St., Ste. 300, Elizabeth City, NC, 2709, DCM representatives can also be
d
of (262) 2tMail,0q. No response Is cons(dersd the same as no objoction N you have been
notified by Certified Mall.
1 ar,7erst.nd that an WAIVER SECTION
(wn y proposed pier, dock, mooring Pilings, boat ramp, breakwater, boathouse, lift, or
this dog beset back a minimum distance of 15' from my area of riparian access unless waived by me
the a not aPPly to bulkheads or ripiap revetmonls). (If you wish to waive the setback, you must.tan
oP ate blank below.)
1 DO wish to waive some/.,, of the iS setback
.OR. Signature of Adjacent Ripnrtan pp roperty Owner
to waive the 15' setback requirement (initial the blank)
t do not w sh
%natty, OF Adjacent Riparian Property qwne
Typatl/Printed / r
Warne of ARPO: q'�E�,}t-� .
Mailing Adaross of ARPO:
ARDO $ anrafP. S t r� J Vti htlP(1 p/! (k 1%()u r ( UM --
bate: ARPO's Phone#:
y
% for up to one year from ARPO's Signature*
Revised July 202 f

_
i
I
_�T
_�_�JY- !-' I! 1 E
i I I i! i _'r
I_._i
_I
_EF
i T-V
Qj
Aa A-_=.=__
T i
1
_� � i � � � � �
I _.
_
� J_J_-�-
-JL
X
dii
-f-
IL

t�
,tiw
r:`j
J}
^
t