33669_SHAMBAUGH, JULIE AND TODD MILLER_20030402

71CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit #
❑New -]Modification - Complete Reissue-Tartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name iul '4&-- ..,(L P ,14 /�►
Address
City ri,4 State ZIP__
Phone # )39 3 Fax # ( )
Authorized Agent SE 1►•
Affected EI CW ❑ EW E PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑FC:
ORW: ye j/ no PNA yes /!ni? Crit. Hab. yes / no
U
PS7t
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City _. ZIP
Phone # ( ) River Basin
Adj. Wtr. Body ?� , •, f % v �c l (&t-, /man /unkn)
Closest Maj. Wtr. Body v r % v H of
Type of Project/ Activity r c rl C if r v
f ' �,.Ivt v h • !~ �� �� f ti n� L 1 i, 4J (Scale: N, rF )
Pier (dock) len-h I : r
Platform(s)_
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin. channe
cubic ya
Boat ramp
Boathouse/ B,
Beach Bullcim
Other
I ,
Shoreline Len
SAV: n,
Sandbags: ni
Moratorium:
Photos:
Waiver Attacl __ / "►1
A building permit may be required by: (G' I tr F ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions fV V r �- • j ° c' •a ; p N i ► rd
Agent or Applicant/Printed Name f
Signature Please read compliance statement on back of permit
t515
�t
Application Fee(s) Check #
Permit Officer's Signature
7 7 - C;
IssuingDate Expiration Date
(of -its r� �t j, �� Z ! G A
Local Planning Jurisdiction Rover File Name

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 1) 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

I.
I
Julie A. Shambaugh 55-30/531
Todd L. Miller 341 4595
394J Bell Ln (Ocean) [phone]
Newport, NC 28570 DATE � A L�
PAY TO
ORDER F G � v ORDER OF ---____-- C� ��ro�(/S(� iACj(`�l-�'
e 1�t:7
l rsrk for. Miuo Print slgnaturc hnc. gray type and lintworl. Lust Citizens Hank logo on ba�A. II not prescnL Jo m.i DOLIARS
u 7ENS 341
Firat s'oro.s Bank 8 Trust Company
Svrensboro, N C. 28584 `�' •L/'_J
www.fr tdtkens.
FOR4?-?"�--Z3
1:0 5 3 1,00 3001' .003417S qa 4 9aill 04595

ADJACEI T RIPARL-�N PROPERTY MNNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOCSF) Mpg 18 2003
I hereby certify that I own property adjacent to` +%L4 J Ly " s
(Narne of Property Ohner
prope.ty located at
(Lot; Block, Road, etc_)
onr''� �� ✓ %� , in(?, �-,,i CCU ►-�c-ft , N.C.
(Waterbody) (Town and/or County)
He has described to me, as s<<own below, the development he is propos:-_ at that location,
and, I have no objections to his propos 1. I unders=d [.ha. a pie:/mooning
piHn2s; aoadift/boathcuse must be s:._ back a minimum distcrice of f ift-=1 fer: (5') from my arf-,Z.
of rDa-ian access unless waived by me.
`/ I do rint wish to wage the setback requirement.
I do wish to waive t.at setback requirement.
DESCRIPTION AND/OR DRAWD G OF PROPOSED DEVELOP`fENT:
(To be filled it by irzdividacl proposing development)
��t �AdOt'f / W, ( L__.'_e t�__
.Z 3 O 1
3L
C
Signature
2_6It� r
Print or Type. Name
`� 10 - 2(-C K - Z_
Telephone Number
Date:

ADJACENT RIPARLAN PROPERTY OWINTR STATEMT- g 2003
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
"�r�tC i
0,,M ��_zI hereb certi� that I own property adjacent to — l <<� Vt'-L' (e, s
Y ry
(Name of Property Owner)
grope. �y located at
(Lot, Block, Road, etc_)
on �'� { S �� ,�� , in
(Waterbodv)
(Town and/or County)
u
, N.C.
He has described to me, as s<<own below, the development he is propos - a_ that location,
and, I have no objections to his proposal. I unee:s_nd ti;a= a pier/moor�nQ
pdin Es aoadift/boathouse must be se, back a minimum dIS Ce of fii een f:r: tom my area
of riu ian access unless waived by me.
I n nn wish to wa:%"e the setback requireme: t.'
6i
FA
I an wish to waive t.at setback recuirement.
DESCRIPTION Ati-D/OR DRAWr G OF PROPOSED DEVELOP`tE\7':
(To be filled in by individual proposing develo nr)
NjV
��J `elf✓
U 3o
�OGK
Signature
Print or Type Name
2-6
Telephone Number
Date: 3 / i 103

16
o'
m
IL'
1�
a
J
30� oF7
ooc-'
-> I W / � I � d / r � �( )V- ) / U ) �/ // V )e ,
I-cr N/ t O Q`it
Lf
(---" )�r
MI-��y tV if-( t=0