Miller, Kevin

AMA ❑ DREDGE & FILL .14A,gyp
ENERAL PERMIT Previous Permit#
ElModification ❑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 •ommission in an area of vironmental concern pursuant to 15A NCAC
❑l4ttiles attached.
Applicant Name IJ�""� tf Project Location: Coun R1
�� j ty' .
Address ;* .1 0- Street Addrrgess/( State (Road/ Lot #(s)
n for
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Authorized Agent ,�"�,o /*�.� City— `• ZIP
Affected P `•• "-'' 'A C3+ S ❑ PTS Phone # ( ) Riv r Basin i �d
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): ❑ PWS: Adj. Wtr. Body p na man unkn
ORW: yes / no PNA yes no Closest Maj. Wtr. Body P
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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, certifythatthis project is consistentwith 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth Citv 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

AMA / O DREDGE & FILL
ENERAL PERMIT A B D
Previous permit #
ew OModification OComplete Reissue OPartial Reissue Date previous permit issued:,
wthorized by the State of North Carolina, Department of Environment and Natural Resources / f,�-711 /7cu
the" Coastal Resources ommission in an area of vironmental concern Pursuant to I SA NCAC l V
[SMIes attached.
,ihcant Name "� Project Location: County'
ress _ - - f _ Street Address/ State Road] Lot A
- -
If
,fg4 State AK ZIP'�k' te'9
ne # 0 ) .r E-M it Subdivision
loriied Agent, p City ZIP .
cted W ''— �' A ❑ PTS Phone # () ,,,,.River Basin
❑ HHF ❑ IH ❑ USA ❑ N/A
,(s)rOEWA El PW9c Adj. Wtr. Body ' na man unkn
N: yes / no N PNA yes rno) Closest Maj. Wtr. Body 3
w of Project/ Activity An, �, Itt PA CJ Y > i>
/-An
.� 1, g
1c�9 4 (Scales )
;r (dock) length &
... d77 %.-
>ating Platfi
)& piers)
pin length
number
I he / RiF
avg dist
max.dis7
sin, channe
cubicya
at.ramp _
athous
�—
ether
shoreline Len
SAV: " n
ng Pe
Loca
PermitO c Pi
statementonback ofpermit" Signat re
Check# IVM,ngQa e
§kpiratit
Dat
1 _

Name of Property owner Requesting Permit:
Mailing Address:
-
Phone Number: 0
Email Address: vv 0-c ky, V I La VV I-C .)v I ka I
I certify that I have authorized
hnani /
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the follovving proposed development:
�OCJ- h'
Y
at my property located at Z
in (4.e County.
/ furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit officer and their agents to enter
on the aforementioned lands in connection with evaluating infonnation related to this
permit application.
Property Owner Information:
Signature RECEIV
"1 11421, APR 0 6 2017
Print or Type Name
DCM- MHD CITY
Title
Date
-311
This certification is valid through I , - - �-L7-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that i own property adjacent to r $
(Name of Property Owner)
roperty located att n '
p
. (Address, Lot; Block, Road, etc.)_ .
on r , in 5 vo c,VI r, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
is-
i have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/Ott DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in descelption below or attach a sife'drawin91
� See A 44 det�
RECEIVED
APR 0 6 2017
DCM_ MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.
<��l do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Prope Ow er Information)
Si nature Signatut.
Print or Type Name print or Type Name
Mailing Addre s Mailing Addr s l
Cqe
Ci /Sfafe/Zia Citylstafe2ip
r Telephone/Number/email address
Dade"
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I awn property adjacent to `�` 's
(Name of Property Owner)
property located at ( 1 1
(Address, Lot, Block, Road, etc.).
� ? in c s C) r 1' N.C.
on -
(Waterbody) (City/Town and/or aunty}
The applicant has described to me, as shown below, the development proposed at the above
loc ioty
(5 l have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
nrnnncinr, rtav Ienm of rxrusf fill in description below or attach a.s/ts drawing)
RECEIVED
APR 0 6 2017
®CM_ MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.
V. �-Af.& I do not wish to waive the 15' setback requirement.
(Property Owner Information)
r
j
Signature
tint or Tvoe Name ,
Date
Number/email address
(Adjacent Property Owner Information)
Print or Type Nam
�t�
�e'5'
Mailing Address
/YLmYt4j r/44le AIL 2�11ir
CitylStatelzip
?©41— 662--
rri� Telephone Number/email address
3 /ZZ -a/ %o / -7
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature}

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