Miller, Charles

�1-
CAMA /,- DREDGE& FILL No. 73322 A
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 cc,19cern pursuant to 15A NCAC
Applicant Name
Address
City State ZIP
Phone # ( . E-Mail
Authorized Agent
Affected Cw EW PTA ES PTS
AEC(s): OEA HHF lH UBA N/A
Pws:
ORW- vp- no PNA ves / no
B C D
I Rules attached.
Project Location: County__
Street Address/ State Road/ Lot #(s)
Subdivision
1 City ZIP V
Phone # River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Shoreline Length
SAV: not sure yes no
f®r
Moratorium: n/a yes no,
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s)
Permit Officer's Printed Name
'S' n r ssu EN) ssuingDate /Expirlti n

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 F— 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 howto 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/ 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 7/06117

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:1-
c�cC. 25 �L(
Phone Number:
Email Address: �tM`� l (Q�'yrr Qc �rB e�wc
I certify that I have. authorized
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _e.,-!Ld.
at my property located at i 3 7arL (',o,, r
in County.
l furthermore. certify that / 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
�-lws -14, 41
Print or Type Name
Title ^
RECEIVED
Date
NOV 3 0 2018
This certification is valid through 11 _I DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e:- �. s
(Name of Property Owner)
property located at 10 --� 'Pc'-tL
(Address, Lot, Block, Road, etc.)
on Vf ki r in C"-pe- Ca.-k c-e+- N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
z�I a 'on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
I `7D
SPA"
j+
WAIVER SECTION
Ijunderstand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must b et
back a minimum distance of 15' from my area of riparian access unless waived by m( u
wish to waive the setback, you must initial the appropriate blank below.) RE,C
V, — I do wish to waive the 15' setback requirement. NOv 3 p Q1�
I do not wish to waive the 15' setback requirement.
c�GM'
(Property Owner Information) (Adjacent Property Owner Information)
Signature zgn ture
Print or Type Name Prin or T pe Name
Mailing Address Mailing Add ess
c 1x kerCI i
City/ tatelZip City tate/Zip _
2-5 7 - 76 if - QL,2 -
Telephone Number Telephone Number
H- 7-7- ?00f '//- -2L
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t l u' e S I' .. tl e s
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on Te4-,'l,o4 N- in CaOc Ce:r-ke-ei N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
�riT l I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
l r�n�s n q % -tl
Se-
1
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must
back a minimum distance of 15' from my area of riparian access unless waived
wish to waive the setback, you must initial the appropriate blank below.) �t
set
I do wish to waive the 15' setback requirement. N0� 3 U zw%
I do not wish to waive the 15' setback requirement. DCM.MHj) (;%Ty
(Property Owner Information) (Adjacent Property Ownerformation)
Signature Signature 17
C ter lei, ram; 11 ��� l - -�C{ r(I
Print or Type Name Print or Type Nance
tear
Mailing A dress �C Mailing Address,
Mf
City/Statel City/State/Zip c-1 � , .,
.zsZ- j��l- 59 1 - & .3,- _ 717S
Telephone Number Telephone Nub� r
1t- 2?- ?01K -
Date
Date
(Revised 611812012)

cn
�
o
a
m
m
CD
�.
f_OD
m
Q
rt
`
O
D
N
-t
N
Z
p
CL
p
m
cp
y
y
v
O
�
D
CD
N
0
N
(D
CD
(D
A7
"
N
CD
Z
�
L
p
C
A) y
co
..
._.
2 00
CD
O
a
0
-�
n
0
0
CD
7
C
rt
p
3
:D j
y
o
0
S
C
CL
7
n
Jr
v
Z
O
<p
c 0 0
.wi
k
,t
4
i+
0
i