63145_Pier,platform_20180831

7.­ .%f-
iiTOpp
)�6WA f D 'DREDGE t FILL O. 72424,
_T
GENERAL PERMIT Previous Pdrmit*,*A --I
INew -[]Modification []Complete Reissue ElPartial Reissue Daie,pee"vious.per'm'li,issued'/U/�
e oii'na, Department As authorized by the State of North Car of Envirorimental'Quality
-Commis sio n in an ar
-and the Coastal Resources ea of environmental concern'p u*rsuant to 15A NCAC
JZR I c h P-d.
Applicant Nameproject Location: County -
Address f Street Address/ State Road/ Lot A(s) 717
5
City State A) VZ 21 P2 "a 7
IP2�1?
Phone# E-Mail Subdivision'-
Authorized Agent 11P1114 Ci ZIP
Ri[yer Basin
El CW' �(EW ;VPTA 'EIES- El PTS Phone #
Affected
El OEA E-1 HHF, 0 1H E] UBA 0 N/A
AEC(s): - Adj. Wtr. Body ,mom)
o Pws:
Closest Maj. Wtr. Body—
PNA yes ORW:' yes / 6). 1
,Type of !�;(,e FA e�
(Scale:
�Ar (clock) length, 1,k
M. M.
M. MEN
MENEM■ LIMMUNE■
■MEN
■■■■■■■■�■■■■■■■■■■a■■■■■■■■■■■■■■
INK MMMMAIMMEMMErmin
'jM=MMMMMMPMMMM OEM
.. ........�■
ENNEMMEMOMENHE
. /
Ple'ase'read'compliart(cerfsiateme,nt on back of permit"
1 1. 1
t 'Mic4tiob Fee(s) Check#
issuing Liate - . expiration Liate

ADJACENT RIPARIAN PROPERTAr
Y.OWNER STATEMENT
I hereby certify that I own property adjacent to �/qAj Ta bj4- s
(Name of Property Owner)
propert cated at A J'�� )4
r t % (Address, Lot, BI - ��R,,o.�a-d- etc)Ve
on /i Gt� /�r ve- , in �i
(Waterbody) (City/Town and/or County)
N.C.
The applic has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
gto,, g kZ-JZ-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
I do not wish to waive the 15' setback requirement.
(Pro/perty Owner Information) (Adjacent Property/Owner Information)
! ... l LC
Si t r �� �Si nature
YA {
(P gLn �6 IJ JCe
Telephone Number
Date
Date
(Revised 611812012)

AD.SACENTR1PARIANFROPEMY:OWNER-ST.pATE—ME—NT_
I hereby cer#ify that I own property adjacent ito _ Mr 1 1
f r �— (M a pS Rroperty Owner)
property located at l g ' 1 /�s� /�� '—e
t %PSWV 1 GJ,, 'L�:/{�YJI V %J J\l'JC3y,
- lakerbodyj (GityJTown and/or:County)
The applicant has descftad to me, .as shown below, the .development proposed .at the above
d9LI have no -objection toIhis proposal,
d have obiections to .this proposal.
DESCRI--PPOTV AND/OR DRAWING O'r .IIRGIPOS°ED DEVELOPMENT
(Individual proposing development must.fl tin description bc-low or.aVaci7 a site :drawing,
I0��� P
WAI VER SE.CTiON
t understand that •a pier, dock, :mooring ,p;,Rncs., breakwater, boathouse, lift; or groin -muet be set
back .a minimum -distance of 15' 'From Amy area of riparian access ,unless waived by. me. -(!f you
wish to waive -the setback, -you •must Mit:iai the appropriate blank below.)
_68 l do :wish .to :waive the I Setback Tequirement.
1 zlo net,wish to waive ,the 15' setback req-uIrement.
-(-P.rope�:0 rinianrnation,) ( jace3rt'I�r rae>'�� O frier ln3otmati )
1
.Signature
Pript y�e N a , nt or T e:;lfam ,
IV, mgAddress � tf �ttrn ^dd. Ss
�Jc p_-�.� ltr �—�� a �T � ��c� llelc o2 7�'7/
Cit /Si tL'%liD Cr/+ .7 -971k
r� phone NumberTQl�ephort„
V
Date Dare
(P,.evised 6/1SQ012)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Millard R Juba
Mailing Address:1566 Harmon School Road, Princeton WV. 24739
Phone Number: 304-300-1896 or 304-586-2995 or 304-425-7686
Email Address: [e-mail]
I certify that I have authorized Mr. Marvin Boyd
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Replacement of dock
at my property located at 318 Pine Tree Path, Bath, NC. 27808
in Beaufort County.
I 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:
��igffAIRA)I,
Millard R Juba
Print or Type Name
OWNER
Title
09/08/2018
Date
This certification is valid through I 9

NC Division/of Coastal
Applicant: `//GC� v04
Date:. / ,fad-�/p
General Permit #:-gz4,-Ze/
M9L Habitat Impact Computer Sheet
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 ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
_
Dredge ❑ Fill ❑ Both- ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised:02/03/10