West, Millard

AMA 0 DREDGE & FILL 62132C,
ENERAL PERMIT Previous permit #
Nevv ElModification OComplete Reissue D Partial Reissue Date previous permit issued
As auth rized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmelntal, c ncern pursuant to I SA NCAC
-iZ Rules attached.,
Applicant Name IL k I tr, ^ v i - ----- Project Location: County_ t Sri
t (s)
Uk Street Address/ State Roa
!Address X� d/,Lo
;City State ZI
P /10
Phone # Fax # Subdivision_�
Authorized Agent City
:PTk11 TA ',AES El PTS
Affected Phone # River Bash
as
El OEA 0 H EIH El UBA El N/A ,
AEC(s): Adj. Wtr. Body or �(Inat fmaWZ7unkn)
El PWS: 13FC-
'r - ) *
OIRW: yes / CZ,) PNA yes rn� Crit.Hab. yes no Closest Maj. Wtr. Body
Type of Project/ Activity /A
(Scale:
Pier (dock) length
Platform(s)
Finger pier s) --- — — — — — — — —
Groin length
-n be
prap length W�Jljy
B 71k�'e J;U.
avg distance offshore
e
max distance offshore
Basin, channel —7—I l I1
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
'-'Shoreline
Length
SAV. not sure
yes
no
;Sandbags: not sure
yes
0
,Moratorium: n/a
yes
no
Photos:
Yes
n
Waiver Attached:
A building permit may be requirei
01
"i- -) (' k ( k I k I \ , , n See note on b4ck regarding "Ri 7er Basin rules.
r 4
Ut
kq, "N
If
-LAY
Permit Officer s Signature
Agent or Applicant Printed Name
!tLAA,
Signature P1 ease r ad mpliance statement on back of perhiit
Issuing Date
Expiration Date:
Application Fee(s)
Check#
Local Planningjurisdi(Won
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 (252-946-648 [)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/ I-888-4RCOAST
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

Dlc DIVIslon of octni 51j]V2. Flabitat In, pract Cats` Zh000t
Applicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge 0 Fill)� Both [I Other ❑
Dredge [I Fill 0 Both El Other 0
Dredge El Fill El Both [I Other C1
Dredge El Fill [I Both [I Other [I
Dredge [I Fill 0 Both 0 Other [I
Dredge [] Fill E] Both [I Other El
Dredge El Fill [I Both El Other [I
Dredge [I Fill [I Both ❑ Other ❑
Dredge 0 Fill 0 Both 0 Other [I
Dredge [I Fill [I Both [I Other ❑
Dredge [I Fill El Both 0 Other El
Dredge 0 Fill 0 Both 11 Other [:1
Dredge [I Fill [I Both [I Other El
Dredge El Fill [I Both [I Other [I
Dredge [] Fill E] Both [I Other [I
252-808-2300 :: 11-8384RCOAST ::
revised: 02/03/10

RCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date —3 —"4._. 'P % _
FA
Applicant Name
Mailing Address
I certify that I have authorized (agent) Y6UZW to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) _
at (location)
1'smm* --�
4
This certification is valid thru (date) 3 21 Old'
Signature .
MEIVED
DCM-YO CTTY
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN ROPE Y OWNER STATEMENT
I HERBY CERTIFY THAT I OWN PROPERTY ADJACNET O
NAME OF PROPERTY OWNER)
PROPERTY LOCATED AT Arn(�?�%
(LOT, BLOCK, ROAD, ETC.)
ONL IN NC
(WA ODY) (TOWN AND/OR COUNTY)
HE HAS DESCRIBED TO ME AS SHOWN BELOW, THE DEVELOPMENT HE IS
PROPOSING AT THAT LOCATHON AND, I HAVE NO OBJEACTIONS TO HIS
PROPOSAL..
`�DTESC7�RIIPTION AND 'OR DRAWING OF PROPOSED
DE VELOPM[ENT (TO BE FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
4
��,�
�1 signature
print or type name
Telephone number
DATE, J'- 5

FROM : Caro 1 e J$ & M i 31 and C We St, Jr PHQ`e No. : 2= 7287971
Mar. 05 2013 24:SiPM PP1w��
ADJACENT CENT RZPARM P � l Y OWNER STA 1 E1VfENT
f
IHMYCERWY THAT I OWN A1JAC1'►Ei" Ti
fiw�r•^
PROPERTY LOCATED ATA�E '4�>
,
=. $LOCK,.ROAD, ETC.)
HE W DSBMMED TO ME AS MOWN BELOW, THE DEVELOPMENT HE IS
PROPOSING AT THAT LOCATHON AND. I HAVE NO OMPACTIONS TO HIS
PROPOSAL -
DESCRIPTION ANVOR DRAWING OF PROPOSED
DEVEL0PN[ENT ao ur wrw aYwwvwALv, o,o= nrvttorna xn
RECEIVED C�
MAR 0 6 Z013
r+Cjr.,!HD CITY
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=,, �-) /q. 41)��
pr rt or type name
number
Z0/Z0 39Vd
ANVE 31VIS S83 q8V d
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