Miller, Bobby 78879C

",/_�K'CAMA/ 7DREDGE & FILL V A B /�C�;� D
GENERAL PERMIT Previous permit#
{lia"evv _�Modifieation IO'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 I'fj •
les attached.
Applicant Name„_ �. - (" (. _ Project Location: County
Addre�s�s �'y Street Address/ State Road/ Lot #(s)vi
City. (�_-- > � "I ... G'11 - State �C-. ZI Ptf_JJ _
Phone # (9 trL)1 13E-Mail Subdivision -
Authorized Agent I L pq
Ag !till f !-'`1 t4 _ ..A _. =— City-
1.....--- ZIP
Affected 7CW W PTA ES OPTS Phone#
_,_OEA rHHF fa NIA�� c_
AEC(s). PWS IH USA Adj. Wtr. Body .- [ c.tyvt ���'t - at an unkn)
t j'
ORW:.. yes I no PNA ,/ye�/ no Closest Maj. Wtr. Body. �/.e(t�--.._ .
Type of Project/ Activity
Pier(dock) length X
Fixed Platform(s)7�
Floating Platform(s)_
Finger pier(s)_
Groin length
number !
t�
ti�L
Bulkhead/ Riprap lergth .1 --
: --
avg distance offshore
max distance offshore
Basin, channel
cubic yards _ --
Bo
BoathousefSasdihi(sZ
Beach Bulkloziing'
Other I f�
-
Shoreline Length
SAY': not sure yes n�oy`'� C
Moratorium: n/a yes
Photos:
Wmver Attached: , yetY ..7° /
A building permit maybe required by: fpj1. G PSel See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) p
Notes/ Special Conditions ! V/b� '112 f� E� s C_" � 2a('Jr iA/r1JC3J:j1/(A a y
S ampliancestatement on backofpermit*
Application Feels) Check #
..... J - .....
PermrcOffice?s Prin e time
Signature
r }.
/ J 3 �_L _ _
Issuing Date P--^^yy���� tion gate

KCX N9 78879 A B D
���GJENERAL PERMIT Previous permit#
Wlaxqew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality '7' I /�J�,,,,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 /�'j • /002
Males attached.
Applicant Name & �6 l ' L� l6� Project Location: County (0n ,�"t, "
Address A0 S611y j/),fA/ D P i Xk Street Address/ State Road/ Lot #(s)
City 0T''�eg C� State � ZI P��tOtL -__
Phone # C ) 5 E-Mail j
Authorized Agent &%nQ� Mg�f��nAS.I
Affected EI CW �W PTA _kES ElPTS
A
Affecte D OEA ❑ HHF ❑ IH ElUBA ❑ N/A
❑ PWS:
ORW: f vek) / no PNA 1/ve4// no
Type of Project/ Activity
Pier (dock)length X
_
Fixed Platform(s) X "A
Floating Platform(s)�
Finger pier(s)
Groin length
J—)__ _
❑�
�—
number �„
Bulkhead/ Nprap length
-
-
i
avg distance offshore /•
max distance offshore
Basin, channel
7�
cubic vards
`,Tr
I
r
Beach Bull zing
Other i li
Shoreline Length
SAV: not sure yes no-
--t —
Moratorium: n/a yes
Photos:
Waiver Attached: ye — /,�j—
A building permit may be required by: AL j P—
pc✓, f I R rc
( Note Local Planning J urisdiction) /(/ r
Notes/ Special Conditions I V b�
u 1 1. At-1- 1�
or Applicant Printed NameXIS
ig ature **Please read compliance statement on back of permit'r'r
3 7 7
Application Fee(s) Check #
Subdivision
CityZIP
Phone # ( ) River Bas',\n' "_a k
c
Adj. Wtr. Body TIr ,, PA,��L[j%r�C�` at an /unkn)
Closest Mal. Wtr. Body /Vfitrl l -) )/ej�
L
Scale: i
❑ See note on back regarding River Basin rules.
k
Permit Officer's Prin a ame
Sign atyyre
3 /_'a I 7bs' 12
Issuing D to Exp' anon ate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: J'1�6f `I" biu 4 M ) l e1'
Mailing Address: �� KIll V l PUS 1117e�
Phone Number: q t 6 - M - IC/A
Email Address: Pnr-1-1.21i ik. net
I certify that I have authorized EbnejL tie ( nk1tIJ4(1< otl)
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I d I X ) 41 �] try 6Q',yS I Q; er;
_ nc.k ISnc-C-. 1VxXt' c-oyey cO ccctiir 15e �i5��<�P4111Y16Slztii�,i1 -�'!
at my property located at _ AY ,lai I V i eu) L c )1 P,
in (001(D , County.
1 furthermore certify that i am authorized to grant, and do in fact grant pennission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
e,r
Pr#7t or Type me
Title
A 71 CALd4
Date
This certification is valid through 1 I
d adv
RECEIVED
MAR 15 2021
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY pVp_g8S1A1EMENT
I hereby certify that I own property adjacent to ,7 L
r ( 'me of Property Owner)
property located at
on
Ethe applicant has described to me, as shown below, the development proposed at the above
I
1 I have no objection to this proposal.
L1t I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(ladlvidusl proposing deve(apmant most fill la dascriptlon below or affach a slte drawing)
r 05C 17ee- Ln+f elc lle.ell Ch'Cf UA M9 I
W—AIYSR SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakWater, b4athQuse, lift, or groin
must be sat back is minimum distance of 15' from my area of riparian gccose unless waived by
me_ (If you wish to waive the setback, you must Initial the appropriate blank below.)
WI
I do wish tD waive the IS setback requirement.
do not wish to waive the 15' salback requirement.
t-011169ftY fawner Information) tlkdiar ant Pi
'Vaud for one calendar year after afgnature'
Owner Information)
tarns i'�i��F� c�ict� yin
a L 27Sz�
WO-1— Sir z?
(RevisedAug, 2014)
RECEIVED
MAR 15 Z021
DCM-MHD CITY

ANT RIPARIAN PROPE" "
-,yeR STATEMIIT
I hereby core* I 1 ovm property adjacent to
y n ��I—s
( lame of Property Owner)
property located at e
(Address, Lqt, Block Road,Aeto•) N.C.
on _ (' (Waterbody) in—� cT(C�n,oLLLwxnRanCdfor County) T
The applicant has described to me. as shown below. the development proposed at the above
11 I have no objection to this proposal.
/ II Lil
.1� I nova objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing devel*Pfi)ent must fill In description below or attach a site drawing)
Fle(1se -,ee
1NAIVER 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 or riparian access unless waived by
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
L41
�_ I do wish to waive the 15 setback requirement.
T one. I do not wish to waive the 15' setback requirement.
Owner information)
Dart
IU,
Taild for one calendar year after signature'
won cfll
cen,pH
(RevisedAug. 2014)
RECEIVED
- MAR 15 2021
DCM-MHD CITY

RECEIVED
MAR 15 2021
DCM-MHD CITY