39835D - Miller

CAMA/ H DREDGE & FILL
iENERAL PERMIT Previous permit#
NewHModification LiComplete Reissue JPartial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natu Resources
:oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC
❑Rules attached.
:Name 61 II d i/i Er Project Location: County ' , <,„)/c
i ,' , - . , ; ,, . c_)c C.f ! :i.vac L. Street Address/State Road/Lot#(s) I-
State JC ZIP 'I tr`i (X.-CU,i b1"C L.L!CSrt /vcL
( ) Fax#( ) Subdivision
ed Agent (k4 5in, .7Ga rr 6,,h c City l?(_;. ,:) /5/c /3«,r. ZIP .28 Sie,'
Ecw t .'EW PTA ❑ES ❑PTS Phone# ( ) River Basin L t/r
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑PwS: ❑FC: Adj.Wtr. Body i iL Lc (nat C
yes /� ono PNA yes / Crit.Hab. yes / no Closest Maj.Wtr. Body
Project/Activity
(Scale: /"e.
:k)length ` 1(/& t
(s) ; 2.0. T 1 I l
er(s)
i {
I
Igth I ( 1
nber I I }
f1- 4I/Riprap length I i I
distance offshore _
x distance offshore i ( _ r
# ' ��e ._
1 _
annel
tic — — — --1—
Yards � I
1
'
ip T
r r d _ ` f-— ; t / - _ "•.
i
se/Boatlift - .
i I i
i 1 i _ , �e
:, i I —t-
iIldozing t 1 I ;' I '� I511wjE o•61
i
I r fa I
Length '
not sure yes no i i l I
I: not sure yes no i �
um: n/a yes n-d i f ... T........, i—
r _
i
yes /no 1 �. _ -
ttached: yes no
ig permit may be required by: . 0 See note on back regarding River Basin ri.

. GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: -bill IA L Clvt<
ADDITIONAL NAMES:
SEC DESIG: l=w hT DEVELOP AREA:__. O 2 PROJ DESC: P - 12
Will only take 6) (Will only take 1)
WORK: P2 i to,3
Will only take 4)
TE $,Zo
vIAINT:
Will only take 4)
MP: U GO 1&O
will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: i1/41/- 40145-
CAMA MAJOR DEVEL REQUIRED: ///1�� `7/rb f

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: i3II ( )A III_
Address Of Property: 133 Oe I e , vv42s+- I V c .
e a►k.) `ems I e Bri cc
(Lot or Street #, Street or Road, City & County)
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,
should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed , please write the
Divisions of Coastal Management, 127 Cardinal Drive Extension,
Iiillmington, North Carolina, 29405, or call 910 395-3900 within 10
iays of receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail.
WAIVER SECTION
C understand that a pier , dock , mooring pilings , breakwater , boat
souse , lift or sandbags must be set back a minimum distance of 15'
:rom my area of riparian access unless waived by me. ( If you wish
.o 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.

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete 411 i gna r� ' ❑Agent
item 4 if Restricted Delivery is desired. �f y El Addressee
• Print your name and address on the reverse 10
so that we can return the card to you. , : :ived pj(P il ed Na to ( . Date Delivery'"
• Attach this card to the back of the mailpiece, .' ] ! Da 0
or on the front if space permits. �t /
D. Is delivery address• -ent •I item 1? ❑Yes
1. Article Addressed to: If YES,enter delive -ddress below: ElNo
eLkc'Jr ts Lt15
ZDo( Ku, kQ iASA,
Ctu Y� 1 O 1 \e N C' • 3. Service Type
* i I v "\ 7g.certified Mail ElExpress Mail
a8 !�a /0 ❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7004 2510 on-no 7054 8045
(Transfer from service la
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Sign ure, n
j//
item 4 if Restricted Delivery is desired. X ✓ 0 Agent❑Addressee
• Print your name and address on the reverse
so that we can return the card to you. B. Received bylPrinted Name) rate of Delivery
• Attach this card to the back of the mailpiece, �,/, iCe I. /30
or on the front if space permits.
D. Is delivery address different from it 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
•\,C1 Ot, U�lfpt�1` xmc
of `,U{E�`
Me bow\e t ` v a - 3. Service Type
Igi Certified Mail 0 Express Mail
130 a- O 3 p p �p S 0 Registered 0 Return Receipt for Merchandise
0 Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7004 2510 0000 7054 8106
(Transfer from servo.—.--., ..PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540

AGENT 346035 DATE 011805 ('� 44
u 82-40/1021
TINL 1249 01 1 !I I: 4 V
080565310367 LOCATION 000119-i;1,4A N #!k##
** PAY EXACTLY ONE HUNDRED DOLLARS AND NO CENTS ************
PAY EXACTLY /�
LOAD THIS DIRECTION,THIS SIDE UP PAY TO ORDER OF E NC N /112 PAYMENT FOR/ACCT.#
�„D 3 9 X URGNASER'S ADDRESS �'/�� �—
O PUPCNAe�a,5r0�f0a R1w[N
I PUNCHA9ER pI SIGNING you AIMEE TO THE leen ON THE aeyESSE WE.
Western Union Money Order and Design Is a service mark of Weslem Union Holdings,Inc/Payable at Wells Fargo Bank Grand Junction•Downtown N.A.Grand Junction,Colorado
: LO 2 L001,001: 1.001305653 LO 36 7n'
OD
1-1-1 W B of t 4` MONRY 0:DRR F1EC PT w ION 1 E13O A:
r
m Z t E E 0
Q gl= O
C7
w Em-0
v>
Z ] AGT 346035 Dt 011005
$100.00 **1HUNDREDDOLLAR1 ANN NO CENTS p
Z i z Q in
O 1,. v n
z CeCZI 1 ToEE r C)
3y 2 g m u l J Retainl this purchaser's copy.I must be Included with ell refund requests.Be sure to reed Important information below e to Z
C 02_o don back.
0— s=i _ — PURCHASE AGREEMENT:You ore purchaser agree that Integrated Payment Systems Inc.need not slop payment on,or
_ replace,or refund a lost or stolen Integrated Payment Systems Inc.Money Order less 011 you hll in the tang of the Money y
e d Order I the lime I p rchase. nd ms y r pod the loss to Ihell Io Inlegrntetl ee B S IP s Inc riling immerlialely.
w `B i E o o In
(� Issued by Integrated Payment Systems Inn.Englewood.Colorado For customer se ice call lii;ngg9660
�T
CO * 08056531 03 6 * o
w •ew
0 to s ;tipCO 0 1$2 joillillUalallillil �
CC G7
z $-.E Q
.,. iS T
z : nag Li.„ Q
in w
,, Vg E'm
.43 'yw y
M , yc S-E
~ a'.ia m0...2
d113O1S SIHl`INOLL036110 SIHI OVO7 •► •