89870A - Miller

❑CAMA ❑ DREDGE & FILL N9 89870 A B C D
a Previous permit
GENERAL PERMIT Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. E]zGeneral Permit Rules available at the following link: wwwdecinc gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wtr. Body r? .. (nat/ma, junk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
Access Length
Pier(dock)length
,-
Fixed Platform(s)
-
—
-
--
__
Floating Platform(s)�
Finger pier(s)
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--
Total Platform area
_
Groin length/p
Bulkhead/ Riprap length
fi
-
—4
Avg distance offshore
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-
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-
Breakwater/Sill
Max distance/length
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-
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-
-
Basin, channel;-
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-
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Cubic yards
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Boat ramp...
Boathouse/Boatlik
Beach Bulldozing
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Other J
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SAVobserved: yes no
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Y
Moratorium: n/a yes no
-
Site Photos: yes no
-
._
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: )<a
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THATAPPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
Application Feels) Check N/Money Order
Signature
Issuing Date
Expiration

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■AGENTAUTH—
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Name of Properly owner RequWN Permlty'`rnwl vv�
g AddreW 11 % ix"y j 2@As Q j
SOU&Vwl%54+a-a 04C, 2igWg
Phone Number.. Boa 1a'-6• aeea
Snell Address: C*) AOtwtyi4�+yS L cprv�
I oerai9 that I have authorized ()k8 IRLU ^' "'S
to aotiM my behA for the purpose of ap*ft for and obb*ft 0 CAMA pem hg
neottssary for the folofw tg proposed developmertk 1 nK boat 1 i 4 1 doc 1E,
Sk s knA dt-ni n
at my property located at 1 t b 4Uck woods aRoi
In O rl..r�e may,
t hrrdremrore cw* that r em auNrorhad to grant,. and do In fact gnw Pemtladlorr $0
DA*jon of Constar A/arbger7rent staff, do Local-POrmM-Ofter and dm*agterrts t0 arer x
on " atrornanomW /ands in o"mcdon ttddr emkoft Mlwnst on rsteMd to Ods
Property Og ler hft' refiat
�D..MgWa
D�ny Miller
PiWcrlypeAhwne
7/BIZ
Daft
This oerWIcattW is vWW through
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-_ N.C. DM8H)N OP COASTAL MANA0EIMNT
ADJACENT RIPARIAN PROPERTY OWNER NoMOATIONIWAWER FORM
CEFMPIEDMse . ET RN RECEIPTR90i
e, (TOP Porden W b8 oompMW by owner or their aperlt)
Nm*ofPrW"owner, K)4 \AfAj'Vt kQIf
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a MOM Addren of Dwnw: —
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a me as Wmm on the MN*Ad dr«�rlw, ais aev'elopibM ear aro 'vrov o• 9
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Wepoeel DO have a6Jedbne blMs propdseL
thk inY pnwow P.bf. pD�t'^•T.. , boWxKme. MQ or Qrdnmuitheoalbwicsni�ir�nd6Nr<naeOT19 nt)hre64fAparltnaooe�suleesreAredbyme theedoec the ePwePAab lyrbara,em.orripratrrorelWAS),MVWwhhtowalretoe wwkyea.te bq�lc 6dow.) MoLtM
I DO wkh tow j s w nWA al do 79 "We*
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sgnatwe a AO)aoait Rlpeden P gmft owner: SQ 9 n
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a N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROpERTV OWNER 1111MMATIOW WAIVER FORM
(TOP Portion W be oornPlefed by owner or their aperlt)
NarreofPmpeltyowrat• O IYq�n(a �A111Qe(
AddrescofPapedy: 11(3 wLK 1nlood3. Rd
Meang Address of Owner: —
Owrrer's einell: f N� „0p Owws pig" t X-9 7) a 31L%a
� Ayen1'sNams:�LanAm NAB � ApeMPhonaR 5a'"1'3a �,Tl"1N
Apen►b Emeu: �L+ax��4tXric;O 9YMa.: \ • Codyl
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ADJACENT RIPAR IAN MROPERTY OWMiRre.ammOATIDN
Ihereby0004Vmt1own praperlyad}aunt10Oeabove rebrorwedpr g'm ii.The kdMduefappiyMefordds
pa" has dowf W b me, e9 sllewn On Vb WNW -O waft the developma Vroy ate pfOP,' W. A
i
•ft th�1Q.: i NOT bare ab)actlons b Vde proposal. hew ObJedgK to Me prepoeal.
-. — �....,, w...r..w...ww.e
to FOR Gd/6T at, 81b. fA' NC OMDW rspreaon6pwt tan Rho be
rr.. «AOf+lY91.IIbrgparlsr/atvr YdfM'�MMMaoobjaeEkokYwhsrebeee
1 und.afand Vert any prePosed pbr• dock � .mM bnftkwm w, boWwLm e..NR or
Groin must be ad bads a ntYlYrasn dbfanos 1w. nfy *" eRfbar6 i6Qm uelees walvad by me
(tldedoes not ap* to hiliftads or dprep np0eV rents), Myou wkhfo waive the setback
V* aYou 153�.>!bG
ppropAete black beWw.)
I DO Wall 10 waive 90"Wall Of file 15' Utbaek
OR Sf9nN neWAd/aoeatV0 ptepwV0w er
I do net w bh b weirs the 151
SOMWM of AdiscaM Rlpadan
TOOMPAnted name o1 ARPL
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ARWssmall: .�L'G� S�'P., (, 771! r K% (T, �Cyy,
'216, 7(RPo'a PhonaN; Q1(3- `%`- 9
Oats % 4(r - `3 'wawa Is VSNd for up to one year tram ARPOy iii*W& ts•
ROWNd Jatr 2021

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