59154D - Miller

2CAMA / ❑ DREDGE & FILL s'
GENERAL PERMIT Previous permit#
2New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized Ry the State of North Carolina, Department of Environment and Natural Resources
1;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�� r ��1- � /�Ci i County Rules attached.
nt Name � Project Location: S l C 1-i
a,- S V / State At ZI Plk-3 *1
/O )Z4,G -zzY Fax # ( )
zed Agent � Q
CW ,. W AIMTA = ES ❑ PTS
❑ OEA ` ❑ HHF / IH UBA ❑ N/A
❑ PWS: ❑ FC:
yes PNA yes /&� Crit.Hab. yes no
of Project/ Activity
ock)length
m(s)
pier(s)
ength
umber
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
ibic yards
imp
Boatli JZ 17,
3ulldozing
ne Length
_
not sure
yes
gs: not sure
yes
1 %
,rium: n/a
yes
no
yes
no
Attached:
yes
no
ling permit may be requirec
Street Address/ State Road/ Lot #(s)
10S:I- cl f��Sf .
Subdivision / Ark ,g'Z J
City c� ZIP
Phone # (7WbZr Z /.3 River Basin
Adj. Wtr. Body LZ;Vl�'A7U,&J(nati
Closest Maj. Wtr. Body e' P S,p o�
atG�l4
(Scale:,1 /I_

WCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date ,,-k3 /% = �
Name of Proper O ner plying for Permit:
; 6?1" A)' flz��
Mailing Address:
kePeln;v') 1 ;
,�- �3'1
I certify that I have authorized (agent) oL I JsQ Mqto act on my
behalf, for the purpose of applying for and obtaining all CANLA Permits necessary to
install or construct (activity) 122,,,4�1, F ,
at (my property located at) !2 05 q qt-k :5�4-1
This certification is valid thru (date)
f
PrnnPrty Ownar CiannhirP
Pate

FPM
A�
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FAX NO. Jan. 22 2012 07'45PM Pi/1
b
iemtte Of :M^iti-idr:2z A ff --
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Aftrass 4:E Pzops� y: p 7
57r�e,�
Cl
Mot or t g . ��.. t
or Road, +: tw..& County)
Y hereby cart:,fy mat -ad nc
-etper®Ced property- individual sit t° the abmm_
des ;; d to me s The
= the attached draaitt� 1ze -Deft tx'°y axe •proposiz9r, A descr ptioh or drawing,� the developmemt
gaauld be '?=O ided with� ts :Letter. vitk djUWn3j s
I:IW no Objeatic.= to thia
T ;4
..bdom.
4 ■ A WW3
I S d #fit -a pier, dn=k. wring .per t
G= mt a.�. tt�lt br a.I- %;a:c m � � :Lt&; a c 02 .t,'a' a:t�
�ij 1iw N-�=�,t8 ■ UL-2 AS IR'A_4eA bV 3JR. ft_, ,xp'1 wish tz
ir- is thQ MPPrgPrxzta bird -C .3
60 +avian to wa" va- :.he l5 ` Se=berit = 7.reman,t .
b*4k �-egnsf.�oa�az.
sicm Kam _ .._ _ _ _ ...�.�•...� i .

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13

)plicant: � Zd a TM�10(
l Permit #: / 1
ate: .Z
:scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
bitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount)
(/)
Dredge ❑ Fill ❑ Both ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
lil
■ Complete items 1, 2, and 3. Also complete
Item 44 4estricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front H space permits.
1. Article Addressed to:
0.96,7 Well t5leI lvl*> ,(
5prv. pr'Nj,o '-� , o j x
—7 g,�*0
2. Article Number-
(Fmris/er fror" spmce /aw
A. 77reX P Agent
Addressee
B. eceived by (Printed Name) C. nof Avery
D. Is delivery address different from Item 1 ? ❑(Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ CertMled Mail ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
7p11 0470 0001 8851 7291
r_1 Yes
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑