55845D - Miller

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
ZNew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized by thg State of North Carolina, Department of Environment and Natural Resources 1
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
(��Rules a
ntName VVU S flK) .
C- .
s)) {"• �)( 3 13 Street Address/ State Road/ Lot #(s)
C I C�I � Gl Y1G)5 State NC ZIP Z95 U11-4 (Cl—k S-E•1�" t'
#( ) Fax #( )
ized Agent &aodui 6nny/SmA B5 AKlrl(
d ❑ CW I(EW )(PTA LIES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes /, no PNA yes / no Crit.Hab. yes / no
A Project/ Activity
ock) length
length
umber
!ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
i
>use/ Boatlift rZ
Bulldozing
ne Length
not sure yes no
Subdivision d —< � DVS sAG�
CiZIP
Phone # (110 ) 9{0.54 35 River Basin ( to p
Adj. Wtr. Body { nat
Closest Maj. Wtr. Body n
gs: not sure yes
rrium: n/a yes no
yes
yes 5n.-
- -
Attached: yes
n_ rr �-
ling permit may be required by: sk)W W Y-t l
-___-_. ------ - -U V?AA A,., - II i U. ., F-,,.I 4C I
(Scale: I //:
❑ See note on back regarding River Basin
Ai.A (,,i.._I \-c, I.,

A�
NCDEHR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date �' 2 v
Name f Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent)
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) co Ce
This certification is valid thru (date)
f.
60
Zv
Property Owner Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to oek iV iS Al I t &,_'s
a
(Name of Property Owner)
property located at'� � � ��
(Lot, Block, Road, etc.)
i
ti on : � , N.C.
(Waterbody) (Tow and/or County)
Applicant's phone 9tt035�'- 3acl3 Mailing Address: T- 0- 6VK 3gi3
C L^41)_S
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 understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
_ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-----------------------------------------------------------------
(Information for Property Owner Applying (Rip
for Permit)
Mailing Address
•----------------
Information)
n / Signature

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qC Division of Coastal Mst, Habitat Impact Computer Sheet
applicant: - b nyjA S
date:
/-3q►o
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
f,, nri in minim Habitat code sheet.
I DISTURB TYPE
Habitat Name Choose One
OlO I Dredge ❑ Fill ❑ Both ❑ Other N
Dredge ❑ Fill ❑ Both ❑ Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
for.
FINAL Feet
(Anticipated fina
(Applied for.
Disturbance total
(Anticipated final
disturbance.
(Applied
Disturbance
disturbance.
includes any
Excludes any
total includes
any anticipated
Excludes any
restoration and!
anticipated
restoration
and/or temp
restoration or
temp impact
restoration or
temp impacts
impact amount
temp impacts
amount
I �o 1
I ao
■ Complete items 1, 2, and 3. Also complete
item 4 it Restricted 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
� 1
A. Signature�r{J � Agent
X j`�� �i 14 t7 Addressee —
B. Received by ( Printed Name) C.,pat ee of Delivery
Gv�Uetf,, -6
D. Is delivery address different from Item 1? �o
if YES, enter delivery address below:
3. Service Type _
❑ Certified Mall ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
C v 4. Restricted Delivery? (Extra Fee) r7 Yes —
745�
2. Article Number
(Transfer from service labeO
71309 28213 - --- 102595-02-M-1540
—
PS Form 0011, February �uu4
Domestic Return Receipt
uieuge Li rm LJ botn U Utner U
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

B AND B MARINE CONSTRUCTION
1168 COREY DRIVE
WILLIAM,'3TON, NC 27892
1019
PAY66-21/530
BRANCH77W9
ToTHE DATE 6r
ORDER OF
4(la-A41A rC f
r)o $
WACHOVIA ------QO—LLAR.S PWaohoNa Bank, 4 dMslon of Wells N.A.
FORL)
-
017 (on)
11000 10 1911. —
1: 0 5 3000 2 191: 2 0 0 o
419 7001IN