Miller, Bryan

CAMA / DREDGE & FILL
GENERAL
PERMIT
❑Blew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
N
No 72097 A
Previous permit #
Date previous permit issued
lutes attached.
Applicant Name ` / f / Project Location: County4 76
.
Address Street Address/ State Road/ Lot #(s)
City* State ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent ( j n City ZIP
B C D
Affected ❑ CW D EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC S : ❑ OEA ElHHF ❑ IH ElUBA ElN/A r�
❑ PWS. Adj. Wtr. Body fknat %man /unkn)
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) t- "
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards %
Boat ramp t `
Boathouse/ Boatlift)
r
Beach Bulldozine
Othe� f UTZ! I "`7fi { J
i
Shoreline Length
SAV: not sure yes no
i
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes n
A building permit may be required by: f � { f 0(,
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name.
r'
Signature**PleasWadcompliance statement onback ofpermit"
Application Fee(s) Check #
(Scale: )
77See note on back regarding River Basin rules.
Permit Officers Pnnted. Name
�---'"
Signature ,r
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 comply with 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(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://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

Name of Property Owner Requesting Permit: _
Mailing Address: 3 V
0
Phone Number:
Email Address:
I certify that I have authorized
11 fl e
/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at �-`4 2 <414 a " It'-0°�' .
inllesll) County.
l furthermore certify that 1 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 information related to this
permit application.
Property Owner Information:
nature
Print or Type Name �y
2 .S— Z -- 3 zG
Title
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
s
(Na��)erty er)
property located at 6-c-) L �C �%l Z��' /'?®T�
�1 (Lot, Block, Road, etc.)
on.
N.C.
in
(Waterbody) (Town and/or County)
Applicant's I- �, z S '
pplicants phone #: ailing Address:
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 AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
11
C-
S
".
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
:z3 �C �2r,wr� :,,.
Mailing Address
r
C
City/State/Zip
`z,�-z - -�
Telephone Number
&tu.yr
Date
� 1 l s r - ��-•�•.,Sig
--• --'�� Signat4tt
Print or 'I*e Name
Telephone Number
Date

I hereby certify that I own property adjacent to Ir Gj � /'5) i l le 's
// (Name of Property Owner)
property located at L C--' /-�` lz "!t /-) /—
(Lot, Block,,, Road, etc.)
on A�e�' /--' G' , in P"� G �4 , N.C.
(Waterbody) (Town and/or County)
,�*pplicant's phone #: 2�r-z- � 7 Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
--------------�� ��- � ---- i---_'/" -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in i y prr-7--'
perty owner proposing development)
IpD
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
41-
Mailing Address Signature
City/State/Zip Print or Type Name
Z 2�,5"`7 Z
Telephone Number Telephone Number
zV l`2.0 2�
1 Date Date

m
0(247
111.10000,
002
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1'CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit# A
[� evv ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Qualityt 0
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
�, J I�Rules attach
Applicant Name ILI r�#) 1 � Project Location: Coun �-t'°
City
Phone #
Authorized AQentt-
El cW
Affected
AEC(s): ❑ OEA
❑ HHF
❑ PWS:
ORW: yes / n&5
PNA
B 'C D
-
I lei V Street Address/ State Road/ Lot # s )
State ZIP / ``tom
E-Mail Subdivision117
v L City_% v` A 1 s `f ZIP �w
j PTA . ElES ❑ PTS Phone # O River Basing {'
I1H ❑ UBA ❑ N/A �
Adj. Wtr. Body i 1% man , unkn
Closest Ma Wtr. Body
yes / no,. 1 • y j
Type of Project/ Activityr ' r
__* a g i f`
(Scale:
Pier dock len h � . x f =w
Fixed
III
Floa
Fing
Groi
Bulk
Basii
Boat
Beac
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Mo
Phot
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A building permit may be required by:
( Note Local Planning jurisdiction) /-
Notes/ Special Conditionsf
or Applicant
Signature ** Ple'2"ad corppliance statement on back of permit
Appfication Fee(s) Check #
_ 0 (I(. Y_See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Issuing Date _` Expiraejon Date