49897_MILLER, PAUL & PETE_20070821

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❑CAMA'/ ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
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 NCA
97C
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Previous permit #
Date previous permit issued
El -Rules attached.
Applicant Name
yA t"N .0 ! 0 - ° Project Location: County ,] ; 'f
Addresses (/> t / /-i! J� Street Address/ State Road/ Lot #(s)
T �"r ZIPs�(1- %�U'�`�
City state
Phone 4 >� ) 7rY -V03V Fax # (,) Subdivision
Authorized Agent City �ZIP , ,.; .
•E7 CW IJEW , 2 PTA ❑ ES ❑ PTS Phone # ( ) Affected River Basin
AEC(s): ❑ oEA ElHHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body ("` = / nn man unkn
❑ PWS: ❑ FC:
ORW: yes / no PNA yes ,r no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity � O X l dU c tic
l3 X% 3 v /1'/ (Scale: ,/(_/ 7 ` )
Pier (dock) length C,
r.
Platform(s)
Finger pier(s)
Groin length
number -
Bulkhead/ Riprap length
avg distance offshore
max distance offshore I^w•� !S ' I
Basin, channel
cubic yards
U i V
Boat ramp
Boathouse/ Boatlift
-jirt� l
Beach Bulldozing
f I
Other
Shoreline Length
;.�
•ti^
4
SAV: not sure yes no
j�
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
r •�
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0
�+ 1
Waiver Attached: -no
yes --
—
A building permit may be required by:
/ - I (/ `
❑ See note on back regarding River Basin rules.
/
Notes/ Special Conditions
YN
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
IssuingD t; Ex0irationDate
Local Planningf urisdiction 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
landowners).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat 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 (910-796-7215) 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.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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)
Revised 08/09/06

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AMOP
ADJE*,CENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/lYIOORINGPILllvGSIBOATLIFT/BOATHOUSE)
I hereby certify that I owii property adjacent i.o 41 M tflGY -1 OP M (IIG1 tTr
(Name of roger iy Owner)
property located at T
(Lot, Block, Road, etc.) AUG 1
on � U � 'a0un � in Oo � CST ad Cti N..
(Waterbody) (Town and/or ounty)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
L-� I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print �orType Name
Telephone Number
"� °_" Date: ( Q
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First Carolina
CORPORATE CREDIT UNION
Eueerience. Stability+. vision..
7-u-" Ant
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www.firstcarolina.org

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE"10ORING PILINGSIBOATLIFT/BOATHObSE)
I hereby certify that I own property adjacent i.ol (u I F M O )e-r a J O P M d l e* t
(Narne of Property Owner)
property located at 4001 Oak .. f re -f
(Lot, Block, Road, etc.) f,
on Baku!_ 5,6lt.1iJ , in1"6 ehead C14w f fr, .j:ht.G. Y OGM
(Waterbody) (Town and/or unty)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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a+ !ow -Fide
Signature
Print or Type Name
j Telephone Number
Date: �! �� -9

MR. OR I
n
0 BOX 98 WRS.PAUL F. MILLER
Elm
MUNUMUM
'-I'll, NC 28580
5629
Pay to the r BRANCH/77648
Order
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