60236_GREG MIEDEN RETREAT LLC_20120516

'CAMA {' DREDGE & FILL NO. 60236
GENERAL PERMIT Previous permit#
❑New (-]Modification 'Complete Reissue ❑Partial 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 I SA NCAC
❑ Rules attached.
Applicant Name
Address
city _
., State ZIP
Phone # ( --) `
Fax # ( �`
Authorized Agent
Affected CW
I- EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF Q IH ❑ USA ❑ N/A
❑ PWS:
i^:FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes ( no
Type of Project/ Activity
Pier (dock) length
Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift ✓
Beach Bulldozing
Other__
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Project Location: County.
Street Address/ State Road/ Lot #(s)
Subdivision
City- _. ZIP
Phone # (_ ) River Basin
Adj. Wtr. Body _gnat /man /unkn)
Closest Maj. Wtr. Body
(Scale:1 1. ) _tr
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File

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:
U 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
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)
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)

lBX
PO BOX 190
ORIENTAL, NC 28571
1247
66.30/531
472
472
Date
Orderrofe � DIV It. DUB Qc)
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First Citizens
Bank
firstcitiz(ens.com
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400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: 252-8W28081 FAX: [phone] Internet: wwwmcoastalmanagementnot
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Pamlico Count NC
County,
Parcel Number:
NC PIN:
L091-3
7510501517
Deed Book:
Deed Page:
529
244
Owner Name:
PARADISE SHORES RETREAT LLC
Plat:
1328 SURVEY WITH DEED
PROPERTY MAP
Owner Name2:
Owner Address:
2103 BAY COURT
Deed Acres:
Land Value:
0
80000
Owner City:
HIGH POINT
Building Value:
37299
N
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T
The on this map are prepared for the Inventory of real properly found within
he data provided
Pamlico County, NC and are compiled from recorded plats, deeds, and other public records
end date. Thla data is for Informational purposes ony end should not be substituted
to aweuThtle seard,properry ationalpurpose only an shouling rriotbe.
State:
Owner Zip:
Situs Address:
Legal Desc:
NC
27265
902 PARADISE SHORES RD
SOUTH SIDE STATE ROAD
Value:
Sale Date:
Sale Price:
117299hin
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125000 One Inch = 100 Feet

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05-03-'12 07:00 FROM-JOHNSON NEUROLOGICAL 3368894629 T-161 P0001/0002 F-883
ADJACENT RIPARIAN PROPERTY OWNER STATEVl NT
(FOR A i'IE pORJ1VG PILIIVGS/BDAn,[FTBOATII]"pilS
I hereby certify that I own property adjacent to _ kLj" kC 01J !s
(Name of Property Owner)
property located at
(Lot, ftek, Road, etc.)
on
►..-t;�i s7,. Ua.:u in
avaterbWY) (Town and/or County)
lie has described to we, as sbown below, the development he is proposing at that location,
and, I have no objections to his proposal. l rmderstand that a pier/mooring piling&%oatlifl/boathouse
must be set back a minimum distance of fifteen feet (15) from my area, of riparian access unless
waived by me.
I not wish to waive the setback requirement.
I & wish to waive that setback requitement,
DESCRIPTION ANO/OR I) AWTN(i OF PROPOSED DEVELOPMENT:
(To be flied in by i"Wdua/ proposhV deveYopAvmt)
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: 61\rcCV.
Address of Property: U )' SL S \no ^e S
[Ae,rif w , NC.
(Lot or Street #, Street or Road, City & County)
I hereby certify that 1 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 description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
10 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Applicant Information)
� 0 �)') 11 t `' 0
Mailing Address
City/State/Zip
Telephone Number
5 1-3/ik
(Riparian Property Owner Information)
Signature 7'�
Print or Type Name
X `l i `t - -19 1-3- r 175
Telephone Number
S-- -7 - i 2-
Date 1 Date
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