59676_MILLER, ROBERT_20111221

'❑CAMA / [:]DREDGE & FILL I �) >! �—
GENERAL PERMIT Previous permit#
❑New El 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 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address
City
Phone # (_ )
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # O -
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH -j UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
r i
Issuing Date Expiration Date
r—
Local Planningjurisdiction Rover File Name

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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 (252-946-648 [)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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808( 1-888ARCOAST
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

ROB, LLC ' 1534
384 BEARDS CREEK ROAD 66-112/531
ARAPAHOE, NC 28510 NIH 01901
DATE
PAY
0 r DEN
ORDER OF K
DOLLARS
BIW—Classic—
BRANCH BANKING AND TRUST COMPANY BANKING
1-800-BANK BBT BBT.co. 'e
Im
FOR

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /oil iac)
Name of Property Owner Applying for Permit:
P,-) � ej 4-
Mailing Address:�[ / ✓�J
SIDS //(eN j WD6US/1
I certify that I have authorized (agent) 3 a L RA Sew 1 1 I to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 1 ✓�G S
at (my property located at) S! o �: �� "od SS 9/� .
This certification is valid thru (date) / , ,1j zO 1 2--
l z )
Property Owner Signature

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: 510
v
of v ct TP .
(Lot or Street #, Street or Road, City & County) I
Applicant phone#: Gael) &1(, - ?7V Mailing Address: _!005' Wwd s _Pp '
N&O Al.C. &s-se_o
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 description or drawing, with dimensions, must be provided with this letter.
XI have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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, or lift 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.
(Property Owner Information) (Riparian Prop" 0W9er Information)
Ra b14i %[ �ai'� c, K f IP,�
Print or Type Name
51 b ,S� r e.4)f
Mailing Address n`
Al/� r3-C.,N . Y►' , C e5 6 0
City/StatelZip
l�s-;) (a(e f q?37
telephone Number
/A/av/II
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Print or Type Name
9I07 TRe t W2ylVA ,
Mailing Address
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City/State/Zip
(aSa ) &3 6 — 9_?F7
Telephone Number
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Date I I Date

12/21/2011 09:21 9195452220 PAGE 01/01
249-35 37 p.1
TRANSMISSI -4 VERIFZCATION REPORT
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DIVISION OF COASTAL MANAGEMENT TIME 1.2120/201.1 21: 11
i ---^^ ---i4��.�R1QAltlAILDDn�cnry .�......-.d......r..�.� --•--- -- - - -
DATE, TTr�I CERTIFIED MAIL_ - RRETURN RECE1f2T�ECtUE�S7ED FAX NO. MAME f
2e 353'--t76
DURATION pAGE[rerby certify that I own property adJacent tobcn . -4 RESULT
mODE
STANDARD(Na.rne Of Property Owner)
BUSY: BUSY/NO RESPONSF(Address, Lot, Brock, Road, etc-)
on f i2� 1 \ in ffe-W RaOQ,✓ N.C.
(Waterbody) IL_
(City/Tawn arsd/or County)
Agent's Name#: �� P',�L'_`
Agent's phone #: e.Z � . V Sf G q , /'r1
H�YShe has described to me as shown below the development #;eishe is prupas;ng at that location,
and I have no objections to the proposes•
DESCPJPTION AND/OR DRAWING OF .PROPOSED DEVELOPMENT
(lnafdvrdual proposing development must fill 117.6 scription "ow or attach a site drawing)
i iir> y� eD
/if you have objections to what is baingprwosed, you ariAsP nabf/y biro wv'1i5mn of Coasts! Managemv_nt
(UCrM) in wlfting wft" 10 days of receipt of MIS notice. Gb►>2act hrfOMAdon for DCM officer is
"40"'able pt w+yw.nccnasialnaangemerri net/corstact dcm.hf n or by catiingr f-Se"RCOAST. Nd
P� o 1S can9/dared the same as ) okjecootr i - haye�b~ 01101lead Der C t,2Med lffall.
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(Property ) i(Rli'46an Prope, Owv r Information)
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Print or Type lvame Pri or Type Name
Prl idmg Acid;,.ss
New) %tn..f & C azVf6C
Cty/5rate/ZIp
lepfro'nt� NumO&r
'aio A� r-
Melling A rdd ss .
_ R WS Oo g,,
C1ty/StAt6/Zip 7
TeJepho ® Number
Date i

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