78052A_Miller, Janet & Roger_20210215

N . 78052 A B �f C
LAMA' DREDGE &FILL O
GENERAL PERMIT Previous permit # C-
[�New ❑Modification El 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 concern pursuant to I SA NCAC
U El Rules attached.
Applicant Name 1,3e � IT k crac V- Project Location: County
Address i u e- 5 C:: i UCi u e r -PCJ Street Address/ State Road/ Lot #(s) /.,c
City v-� �'�� U ` 'Yi �e� , State Pr ZIP 1 C)
Phone # (33(o) 511 L r 21 p (i E-Mail _ _ Subdivision C, C 6ek—,C1
Authorized Agent City_ r. C i, G r` ZIP�-
Affected ❑ CW ❑ EW ® PTA ® ES ® PTS Phone # ( ) River Basin C j
OEA El❑ HHF IH ❑ USA ❑ N/A ^
AEC(s): Adj. Wtr. Body t (nat /man /unkn)
PWS:
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no)
-
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length I U
avg distance offshore Z
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach
Other
•' _I H1 I I I1
Shoreline Length /— Cl (SIIIF I=
SAV: not sure yes io - ---- ---
Moratorium: n/a yes no
- TT
Photos: yes no ram. 1
Waiver Attached: yes no
A building permit may be required by: L 0 W Cn
( Note Local Planning jurisdiction)
Notes/ Special Conditions
(Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit **
Application Fee(s) Check #
(Scale: ! _V )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
� r i, lX✓j...
Signature
,/15 /Li h//5/z /
Issuing Date Expiration Date

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 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 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 - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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

�cr4t:
C},rr+taP'Y'r' or
NafIV Of
T.I.0jore Nur "e" fag nt 00ntr
I Certify that I have authorized lying and obtaining
to act on ray behalf, for the �urpo e of OPP
e e
; ary for the proposed develc���ent cif
at UPY r(,>perly l0r2tcd at
This cerftfication is valid through
(PropertY Owner information
,Signature
print or Type e Nar,16
s�rner s or tr � for
C , �pr°Pert
6V
�.p,....�_. ' jeprt ��but+r
�jjr
i -,\
email Address

I hereby certify that I own property adjacent to
property located at
on
The applicant has described to me, as shown below, the development proposed at the above
location.
-_
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)
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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(P operty Owner Information) (Adja nt Property O -Information)
Claprrone NjimDer i email address
Date
*Valid for one calendar year after signature*
U
Name
MalLg ddr
CitY/State/Zip
- aSaL -; Ll a Z-
Telephone N tuber/email address
Zo 'Z0
Date'
(Revised Aug. 2014)

I hereby certify that I own property adjacent to
property located at
on
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
!/ 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)
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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Information)
Signature
br,-AJJUi s ?dP -Ynq,(\J
Print or Type Name
Mail' Address
7 �V . a 7q
City/State/ZI
- QAd in w I' �GoM�1
ele ho a Number/email address
I�a/e
*Valid for one calendar year after signature* (Revised Aug. 2014)

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