Miller, Bryan (2)

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-1 CAMA / 2 DREDGE & FILLN2 72100 OO A g G D
GENERAL PERMIT Previous permit#
-New 'Modification -Complete Reissue ❑Partial Reissue Date previous permit issued
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
Rules attached.
} r.
Applicant Name __ + I ! tF Project Location: County r �!'`
Address . 1 j1 ` 1 Street Address/ State Road/ Lot #(s) 1 �'
City tTL € State W ZIP ,2 � � �'
Phone # # E-Mail Subdivision
(_)
Authorized Agent ('����<�! City ZIP
❑ CW .-1 1EW , PTA J fs ,-8rPTS Phone # ( ) River Basin
Affected C OEA J HHF ❑ IH ❑ UBA ❑ N/A `, 1 nat man unkn
❑
AEC(s): Ad' Wt Bo d
PWS:
ORW: yes / no PNA yes / no",
Type of Project/ Activity
Pier (dock) length a
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length(c/11V_ I
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing tow
Other
Shoreline Length
SAV: not sure yes no,
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes yno
/
A building permit may be required by: /ttyr i I
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
r �
SignatJ,fe � Please read compliance statement on backofpermit
E
Application Fee(s) Check #
Closest Maj. Wtr. Body 1� cif �'�Z
(Scale: )
See note on back regarding River Basin rules.
f,4,od / fl
PermitOfficer'sNam
sigrlat ke
Issuing Daie 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/17

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27294-22S7 10

CAMA / O-DREDGE & FILL 2 72 100 A B D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r' 0
and the Coastal Resources Commission in an area of environmental concern pursuant to I A NCAC
ul attached.
Applicant Name Project Location: County 6/1,,kiA rt�
Address i D i-i Ve Street Address/ State Road/ Lot #(s)
l S
City r 4 Stated ZIP
Phone #Cj�) -7_Mail Subdivision
Authorized Agent �F .> (" t? City ,f ZIP
ElCW --"E _*"A _4ES _ -;N*S Phone # ( ) River Basin -
Affected ❑ oeA ❑ HHP ❑ IH [IUBA ❑ N/A h
AEC(s): Adj. Wtr. Body tt v.-, ly atl/man /unkn)
❑ PWS: A 7,0.rti . ry
ORW: yes / jno PNA yes /;no;i
Type of Project/ Activity
Pier i
Fixec
Float
Fingc
Groi
Bulkl
Basin
Boat
Boat
Beac
Oth(
Shor
SAV
Mor
Phol
Wain
Closest Maj. Wtr. Body
t-'r
(Scale: I
sh
A bu i
( Note Local i
n
gy
J
u
Np es/ Special Conditions
Agent or Applicant
Signati�e Please ead compliance statement on back
ar
p
er
mi
t
6l.1`
i
Application Fee(s) Check #
f
Permit Officer'sl�Ps►ttedNam ¢
Sig gat e � �_ f � �,,•.
i«J.j, rn,% xoir ion Date

Name of Property Owner Requesting Permit: / -/'/ � � 1�7 /` / �;-"c
Mailing Address:
Phone Number:
Email Address:
o
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessaolor the following pro osed development: 2 O J
at my property located at
in�� County.
1 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 information related to this
permit application.
Property Owner Information:
Signature
lr'o4 -<�
roe
Print or Type Name
itle
r..
Date
k
This certification is valid through / I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to a'7r„Q n �5R,11ek- s
(Name of Property Owner)
property located at 6 O / 4616t" }N T � lc- ,
(Lot, Block, Road, etc.)
on ��fi1-r r ��N. �Z , in �Gtl� l', Lc' - , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 2 Sa- 67)- 7711i, Mailing Address: aj 46 & 1'
Rzt.nuo /Ze 7S5k
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 property ownerproposing devi
1 2 1/,AiyL kL*-14CgD
(Information for Property Owner Applying
for Permit)
Mailing Address
City/St to/Zip
Telephone umber
Signature Date
(Riparian Property Owner Information)
Signature
Print or Type Name
v2---�)
Telephone Number
/o .(2-7, / 2
Date