75562A_Miller, Ronald E._20200515

(C
�tiCAMA / DREDGE & FILL
No. 75562 �
R
GtNEAL PERMIT
Previous permit # A B C D
1XNew ❑Modification ❑Complete Reissue El 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 I SA NCAC
qH - 1 y�
© Rules attached.
Applicant Name ko
Project Location:
County
Address �5 5 _ (� ��, , k.5 �5e ae VN
Street Address/ State Road/ Lot #(s) Lak s C d 2 C 11
City CoGEra, State NC ZIP aq jgq
iyl.tik� LyC?cc, b kcl.
Phone # ('Ste) "S9 N - 57U3 E-Mail %'Y\ ilk 42 r-r e- @ e mbaear +r-
Subdivision
CkC h
Authorized Agent
City c,1CrOL
ZIP
Affected ❑ Cw p EW 0 PTA ❑ ES p PTs
Phone # ( )
- River Basin C %A a c,-lo n
OEA ❑ HHF ❑ IH UBA ❑ WA
AEC(s): ❑ ElAdj.
Wtr. Body
CVc:oan ver {{iafVman /unkn)
❑ PWS:
ORW: yes / no - PNA yes / no
Closest Maj. Wtr.
Body
■■■■■■■■■R`■■■■■®■Ibil■■■■■■■I!■■■■■■■■■■
-A�■■■■■■■■■■■■■■■■■■�1■■■cam■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■�li■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■w
9■■■�i■■■■■■�■■■■■■■■■■■■■
' ■��■®■■■■®■®ems■■■■■:■�■�■�i■■■���s■
. ■■■■■■■■■■■■■►''�■■■■■■■■■
■■■■
iOA
Cii d E " er
Agent or A plicant Print Names
Signature ** Please read compliance statement on back of permit
'lCu. i o 3')y
Application Fee(s) Check #
c, +.'\(K E
Permit Off is rinted Name
Signature
Sir % /'? () /.20
Issuing Date Expiration Date
Z

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 I) 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 O*.her:
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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 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 7/06/ 17

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: 26!5AWC, M;J)Qh
Address of Property: j0-,) 5cA Wk1'4fS Rd c rJzudf►1 NC 1-W z 4
(Lot or Street #, Street or Road, City &County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 sign the appropriate blank below.)
`(Lj?.� I do wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
ficwald E KI NV\
Print or Type Name
i o-� 5oc,, 4, �vh;
Mailing Addresfs�
City/State/Zi
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Signature
Print or Type Name
sl? //, 9J?Z2A15 57-
Mailing Address
City/State/Zip
232--3111t— '�)o 3 ►h,�)eirt e sz►a rrghti8��• -757. 573!2- 4271
Telephone Number/Email Address t10'v% Telephone Number/Email Address
Date
s - S - ZD Zt)
Date *
*Valid for one calendar year after signature" Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: E0,waU5.
Address of Property: �D 5014 �� e Rd L j in �IG Z�94
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
(-'�l have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 sign the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
)�ana)d k.
Signature
Print or Type Name
)63 Sow�Ikllt32
Mailing Address Co rZilk) YVC ;.7c19 L4
City/State/Zip
-L, z- 3cl L�- 3 )o
Telephone Number/Email Address
G�l�� l
Date
(Adjacent Property Owner Information)
r�
Signature *
tier&J,l Be- k4--,
Print or pe Name
4.5 6 , omkb�C4
Mailing Address
J1
City/State/Zip
960 3v3 Z-77,9 I�r`�s ya,l w r�>+
Telephone Number/Email Address
Date
`Valid for one calendar year after signature" Revised 2017

�i
ffidl�