28984_SMITH, TOM_20010927

1
CAMA and DREDGE AND FILL
G E N E R A L�
PERM I T
as authorized by the State of North Carolina 1
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC j
Applicant Name Phone Number
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Address K-i '�•<
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City State zip
Project Location (County, State Road, Water Body, etc.) - l_ % a-, 1 /S I Fa, ,z fir,,
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Type of Project Activity i' +� I, t �j
PROJECT DESCRIPTION SKETCH
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Pier (dock) Len h
( Length
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Bulkhead Length
max. distance offshore
Basin, channel dimensions
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cubic yards
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Boat ramp dimensions
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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, imprisonment 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 of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they
have no objections to the proposed work.
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
y- ; a 11 1
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
ti�9G.LG .k � +`1GU r.
application fee

LT/COL THOMAS C. SMITH 66-152/531 CC 1480
TN 49387172 PH 919-726-1450
RT 4 BOX 288 -200/
NEWPORT, NC 28570
Pay To The Order Of �C /J r/Xi( $
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Oslc /ur�d�' w� �lfo0 Dollars
�TACHOVIA
Wachovia Bank of North Carolina, N.A.
Pine Knoll Shores, NC 28557 Memo \5nrr (:\ /
/y /`'' 'E��./Y
1:05310L5291: 5469 L95041111 L480

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ( O'Vvt Sv ► k is
(Name of Property Owner)
property located at �� loe-gr5r�A/ C//4 /�— ,
(Lot, Block, Road, etc.)
on 81-oceW C`-eel , in Pe- o/'t � C�'-e/N,C.
(Waterbody) (Town and/or County)
He has describers to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Se e - c-1 � c�r
elephone Number
Date:

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S',, ,i 's
(Name of Property Owner)
property located at 21
eon U -1 `, I
(Lot, Block, Road, etc.)
on ,.,,> cric e<< , in C'���2; t-�z; , N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
ature
Print or Type Name
1-4- Z- i cf 7-�k c L I
Telephone Number
Date:

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