12166_MILLER, DON_19940404

CAMA AND DREDGE AND FILL
GENERAL NY 1 ; �s
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC / f:
Applicant Name �f r Phone Number6
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCHY /� f !� j (SCALE:�� )
Pier (dock) length
d
Groin length
l01
number E
Bulkhead length —
ax. distance offshore
4-- -
Basin, channel dimensions. i I
cubi4. rds
t -j
Boat ramp dimensions 1 i FFT i
other
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,
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
wapplicant certifies by signing this permit that 1) this pro-
is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
attachments
application fee
issuing date
r
applicant's signature
permit officer's signature
expiration date

rersonai lvioney vraer
66-30/531 Branch No. i3q
IRMTIFO$IBANK CITIZENS 2026231
3 �5 i94
Pay to the l) ,� u No $ JcQ • 00
order of ` J 1
NOT GOOD OVER $1000.00 -INVALID AFTER 180 DAYS
Dollars
First -Citizens Bank & Trust Company
Raleigh, North Carolina �+ ,, _
Memo �� FCAA �� G C" 6lo Remitter
u' 20 26231I'm -11:0531003001:980799499011'

ADJACLNT RIPARIAN PROPERTY OWNER STATEKENT
�I hereby certify that I own property adjacent to
V ` • 01 � `le� 's property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
on (' in �[ ���11 1N. C.
(Waterbod ) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Te- one Number
a

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ADJACLNT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that
I own property adjacent to
's property located at
Name of Property Owner
V-3 ..47'19e4A ,9,Q; PR w
(Lot, Block, R6ad, etc.
on SOttA G"� �vT� e.o�� in At4AJ f I c- 6 4c� !'v e.
(Waterbod ) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
-001�4 '4t
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Sri) CA -NA --
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Print or Type Name
Telephone Number
Q
N.C.

MUSIC
CITY
DISTRIBUTORS
(WHOLESALE DISTRIBUTORS)
919 - 227-5867
1326 SOUTH CHURCH
DON R. MILLER BURLINGTON N C 27215

MEMO
TO
DATE:
SUBJECT:
r ev�
From:
North Carolina Department of Environment
Health, and Natural Resources printed on RecycledPapei
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