Mills, James

ti
CAMA / ! DREDGE & FILL
GENERAL PERMIT
DNew 'Modification ❑Complete Reissue C'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 NCAC
I ' ] 0
A B C D
Previous permit #
Date previous permit issued
attached.
Applicant Name
_..` ^'+' / ' ? a
Project Location: County
Address
1�'''`-' /',�•
Street Address/ State Road/ Lot #(s)
City
State
ZIP
Phone # ( )
E-Mail
Subdivision
Authorized Agent
City �P, , ^ ?•°l/ loge j ZIP
[WCW
Affected
C EW YPTA a5
❑ PTS T
Phone # ( ) ?� `` f' c ; r River Basin
❑ OEA
AEC(s):
❑ HHF ❑ IH ❑ U13A
❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no
PNA yes /
,
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length = L_
Fixed Platform(s) 14, �� 1
Floating Platform(s) ll
Fingerpier(s) �V o1+pl.
Groin length
number
Bulkhead/ Riprap length ,
r'
avg distance offshore
max distance offshore
Basin, channel
cubic
Boat ramp
Boathouse/
M.
MEN ED MEE
IN MMaW ONE
oil
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Issuing Date Expiration Date

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 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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888ARCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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.nccoastalmanagement.net/
Revised 08/27/ 14

Name of Property Owner Requesting Permit:
Mailing Address:
Lv9
Phone Number:
Email Address: ,6yf v�710, •s e
1 certify that 1 have authorized �Ghei -
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: Alew 6,7a�/,�� ,
Qi h„i/V CX, i+10 i'�ac ` . �s(�e�+ vy �C.�g-.✓r he�rc
at my property located at //7��o�
in C4 rfcrc r County.
l furthermore certify that l 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
5 on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
hiffiWANKIk
Title
l_.2� r.­ / ill f 1-7-
This certification is valid through I
Am

()IVMION OF t,;O"TAL MANAGEMENT
ADJACENT RIPARIAN PROPIRTY OWNIR NOTWICATIONiWAIVER FORM
Nwnn tel Property Owrtar
Atithom of i'rrilmfty �l ` / _ llif!! ar« ,1'rtl, �y�� We k A
/Uartra NranM aY �vl wG �ls ,nai, ti
Auortra piuma #t z j 2 rO'-1 0777
e�'lorej+t�G.`y� -'ZSS 7
1 Itar 1)Y "Wtl y that 1 own pn"ty et*"nt to the abovo rrdtlrer"d woporty The indWkkmi
41)ptyl1
1j
tar 1#11% perndi h" deenrltxW to nM in shown on the aitmell"d drowi the dsve
Itwry *m Iwr>pnwnu A et.AUmdMt.,S*t, tI ntt_ lopnwnt
M111 I have no objawtiona to tM* prop)%ai. I have objactkmr to this proposal.
)hrvw ob/waaUona an what Is barns propoaart, you nruat notk'y Mo DtvWm ofCos Athaeyattnetrt
W010 10 drys of ►mearpt of mto notteo. Contact rnWamsNon for
DCM mlfla:ea h
avnlrnfi/n at e � orbyco#kV I40$ NICOAST.
rr i nab rna ss nu tM►lrtrrNon / you hsva 6400 n*Uftd by CuWW AhM,
WAIVER BECTION
1 undnratnr o tiirit to plot, rttx k, MOOft pilings, boat temp, bmakwnter, boathouse
t��FID
an wd book a minimum rtintanpa of 1 O' f►an my tartoa of rit arlan ceccoaa unless we
You wish to Wawa the aatbatik, you MMtLWM the nppruprlate blank below.)
UK- I do wish to WSW* the 15'setbark requirement JAN 2 3 2018
I do not w►nh to waive the 15'aotbrack requirernont.
.`power° rty Otrw Inlor a }
SY 4,wg
e Pic Af )I oJ
or14po N&m
s'&nW AdilhW
C i.s MHD CITY
(RImmkvrPmp®rtylOwner information)
IMtr
(Revised Aug. 2014)
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DPASION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ✓Af InZLLS �f q,ss ,T !f?li C-S
Address of Property: ZL l Aj_t6_w-ro L <aW t"r_ / ewr Yt>l/rt i tra
(Lot or Street #, Street or Road, City & County)
Agent's Name #:/tee w, l� ��ny Mailing Address:
Agent's phone#: ZSZ 704,
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, rrtust tided wYs this better.
_...____4e_s :-j,
join- I have no objections to this proposal 1.1 have objections to this
/fyou have objections to what Is being proposed, you must notiry the Division of Coastal M?nage rmE of
(DCAV /n wrfting within 10 days of receipt of this notice. Contact information for DCtA offices is
availab/eathttp=liivwwnccoastalmanavement.netlweb/cm/staff114t- orbycalling 1-883-4RCOAST.
No response is consfdered the same as no objection if you haves hPa" nnr:s c.J kv
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived
you wish to waive the setback, you must initial the appropriate blank below.)'
_ 01 t do wish to waive the 15' setback requirement.
10
I do not wish to waive the 15' setback requirement.
(Prope Owner Information)
Sr re
Punt or Type Name
�--
1V817i17g Address
Z?,/, /c _ AIC
Cify�State p
�/ 9 �0 tit OAF -- 4fX
Telephone lvumberlE/nall Address
1 2"0j-
Date
BAN 2 3 Z018
(IISAKto^ry1A# cowitf
(Riparian Property Owner Information)
vqJA R, T
Sign e T
_ *forth 8. MCI -Edo
Print or Type Name
4 I'1 " c.Ap7f P QK,
Mailing Address
CitylStatelZijf
Telephone Number / Email Address
P 14! 17
Lute
CITY
(Revised Aug. 2014)

m
i� it9ry fM►AM
� GC.�,11�IRR.uifftl t1'1C��Ji't
UIVIl;ION Or COASTAL MANAGEMENT
Ata.1Af117,NI "IPANIAN p'hOPNRTY OWNER NOTTA IFICATIONIWAIVER FORM
Nwnn tit f'tt►pnrly Owner l' I AA (I �'.» k l �AA16t
Ad(hawa tit fornparty %% N ""it
0 M 0f or" 0.1111"mok,
i IN►rntly nimbly Ih►at 1 nvvr► PrOl arty "f1jw;orrt 10 the ah0" referenced property, The individual
aappfyktu for till" tra►rrtit flow ffawn►Itt►aft to moo an whown tin the attached drowingfthe devetoixnent
tftwy now pr14r01111i (j;'ftW'AWtl fif*w+f nu. Ylfllll.tllYntltllhill#� t IAM
� ✓ I have nit uhJootkwox tit thin propos, d. I have objections to this proposal.
N yvr. haves r.lr/wrtdnnN b rYAMf M bd ft fry nspd, You must natNy the 0tvislon of CoeaaN Afwmgww9
/to wrtrinp -loom 10 dop of rovw4W at Ode ooft& COMM# lnformatloft for DM offices /s
aVallahla at (r
Or aY Calling I-SSS-4RCOAST.
WAWER SECTION �®
1 understanit that) a pier, do(*, mooring pilings, boat ramp, broakwallter, boathouse, or tKt mutt
b4i Mat bm* a 001111urr) ftialanoM of 1 W from my afw of riparian ao=n urAm w hood by me. (i1
YOU wish f0 wafv* OW 661brack, rxJ V ' �
Y the appropriataa blank bftlaw.j iQ
aK—., I do wish to wahnr the 15' sMtback requlroment
I dO not With to waive the 15' ootbuck rrrquirelnunl
(p rop"
c 1 �
Print or Type Nam*
intorntatlon)
Dom
(Revised Aug. 2014)
(11-7 k 6 f.. fipt

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