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CAMA / DREDGE & FILL Q 1J
31 lr 77
GENERAL PERMIT °mo
Previous permitt# #
New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
© Rules attached. a
Applicant Name 4j tf l y �jy l iL
Address ; .� v WGti'r f "-' 4 P-r- %,d
City State ZIP 5
Phone # ( ) 42(Fax # ( )
Authorized Agent 4a Nn
Affected ❑ CW ❑ EW 2q PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: es / no PNA yes / no Crit. Hab. yes / no
Project Location: County rid 1 4 F , r-�- -
Street Address/ State Road/ Lot #(s)
Subdivision
City[ 1' ZIP lS�/)C
Phone # ( ) River Basin YV I7I / 6&))
Adj. Wtr. Body F u }' J ouMJ nat /man /unkn)
Closest Maj. Wtr. Body rx l „�
Type of Project/ Activity l; ftyf- i r } n W f( a x! r v J VIC
nA14'(, , IA f ' ✓ r, (Scale:
Pier (dock) length
Platform(s) ti Y 12
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
�'i ; � ice[" 7(}'�r � (J ✓ u
11
- `z.i-! •, .r-: +mil-...
(
i ;�r�FfiArt is Ytf���fr� t
Shoreline Length 7, I '
SAV: not sure �kP .vie Pes no --- ;-�--- - -t� w^�< - , -` i-,L - ---- - ---- ---- ---- - -
Sandbags: not sure yes no
Moratorium: n/a yes no --' NA
Photos: yes no ej
i
Waiver Attached: yes ' I t - - - C' ft L►i e
A building permit may be required by: 0 t , 4 (cuo4l See note on back regarding River Basin rules.
Notes/Special Conditions' tj. V1 6.V/a �'° j*dU�ta 31 D Sri _fto1 AL,-cr
�GtulGi� pt+
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
f i"ri : fa rc.
Local PlanningJurisdiction
Rover File Name

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
Iandowner(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 Quality Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 10/C

ti
ferry 3C Smith �&))C 3640984 ss-30�53I
100 WaterfraHtAw 290 2724
Plr 252-726-801 s
AeWrt, NC 2857O p
DATE��_O
PAY TO THE
���� p
y
ORDER OF /�i_v'I�T OIL b-NI/1,0Dd
0I- ri ;
Look for.-S Micro print nature line, a �" v DOLIAfZS
® g ype and linework, First Citizens Bank logo an back. If not present,
do not cash.
OP, fIRW CITIZENS 29°
BANK / B NK Newport, N.C. 28570
FOR
1:053 1003001:00 29075 270 e 7 24

IEN'I
ADJACENT RIPARL-kN PROPERTY OWNER STATEN
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to PUP-g S M / Ti/ is
(Name of froperty Owner)
property located at (/ RTI=F-F )20,,'IT A V .
(Lot. Block, Road, etc.)
on .BO&U6 sOuNb , in WPO12-T , N.C.
(Waterbody) (Town and/or County)
He has described to me, as s1hown below, the development he is proposir. at that location,
and, I have no objections to his proposal. I understand that a pier; mooring
pilings,'boatEft/boathouse must be se_ back a minimum distance of fifteen feet (1,5-) from my area
of riparian access unless waived by me.
I do not wish to wane the setback requirement.
I da wish to waive t:at setback re-quirement.
DESCRIPTION AND/OR DRAWLtiG OF PROPOSED DEVELOP=,-T:
(To be filled ir by individual proposin; development)
2 C�- CO P S" (-T n j t-
cY`1" 4o F'�om 8 X�Z' j�OCrv�
H(.1flLr') C nA1L -Tto yl)
y0
Fob �l 6 ' y"
W AT t�RNop1 Ate.
Signature
Z-:jZIVE-sT D&,&-o�
Print or Type Name
C7 S-r) - -7 "') 6 - 7 U y
Telephone Number
Date: Z
� 4

ADJACENT RIPARL-k PROPERTY OWNER STATENLENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIROATHOUSE)
I hereby certify that I own property adjacent to _ PtV 1Z , 7—IJI is
(Name of operty Owner)
property located at OD W � F' N T )4 lJ
(Lot, Block, Road, etc.)
on I bar 12 E SOcwb , in n) L U, PC V--T , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposir.= a: that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings;boatlift/boathouse must be se: back a minimum distance or fifteen fee: (115') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
V I d_Q wish to waive t;.at setback requirement.
DESCRIPTION AND/OR DRAWr G OF PROPOSED DEVELOPNIEN-I':
(To be filled in by individual proposing development)
9C-(0tJSlrLvcT Attu.
4T- H t:�n P�10 nh
flV"1(-19ue rtc?yL)
XiZ� �C) L' U 6 ov
L Fo & (t I <.,.,. 6 ) , y r, —W> 1 (© ry IV F8
--------- ---------- —---------------------------------------------- ------ --- 7-ft, OA,, --0
Signature
h)J)ULAe—C �- C©mi/qV
Print or Type Name
Telephone Numbe:
Date:

1 1 1
DIVISION OF COASTAL MANAGEN ENT
ADJACENT RIPARIAN PROPERTY OWNER -NOTIFICATION/WAIVER. FORM
?game of Individual applying for Permit:
.-.ddress of Property:
100
(Lot or Street : , Sc: --:: or Road, City & Councy)
I hereby czrafy that I own prope. adjacent to the above referenczd prope-ry. The incividu 1
a;,oivina for this permit has described to me as shown cn the attached drawing the deve:opme:11
:rev are proposing. A desc.iption or drawing, witn camensions, should be provided with this
J
1.._.er.
I have no ooiections to this proposa.
If you have objections to what is being proposed, please wriie the Divisors of Coastal
Afanagement, Hestron Plaza Il, 151-B, Hwy. 2-4, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No resrJonse is considered the same as no objection
if you have been notijzed by Cert led Xfail.
WAIVER SECTION
I 7de:s:and that a pier, dock, mooring pilings, brew �a_e-, boat house, liift or sandbags must be
t�. ,ack a minimum distance of 1 Ii OITi my area of I r' a aC: eSS unlesswa'.�'e� by rile. (":'YOU
ws:l to waive the setback, you must initial the aoprop--ate blank below.)
S i g.,ature
Print Name
I do wish to waive the 15' setback rzc�ire-rent.
I do not wish to waive the 151 setback rec':irzment.
Date
Te:eohone Number With Area Code

Perry K. Smith
100 Waterfront Ave.
Newport NC 28570
111 II 11111 I, 1 11 1111111111111 milli mill 1iI I
7001 1940 0000 2240 7997
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■ Complete items 1, 2, and 3. Also cprgplete
item 4 if Restricted Delivery is desl(#.d.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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A. Received by (Please Print Clearly) I B. Date of Delivery
C. Signature
X ❑ Agent
❑ Addressee
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number (Co'1 7001 1940 0000 2240 7997
P>L?satt Irn Receipt
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Perry K. Smith
100 Waterfront Ave.
Newport NC 28570
102595-00-M-0952
U.S. Postal
CERTIFIED
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MAIL RECEIPT
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Only; No Insurance
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Perry K. Smith
100 Waterfront Ave.
Newport NC 28570

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COMPLETE•N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1, 2, and 3. Also complete A. Received by (Please Print Clearly) I B. Date of Delivery
�.P item 4 if Restricted Delivery is desired.
■ Print ypur name and address on the reverse
so that we can return the card to you. C. Signature
■ Attach this card to the back of the mailpiece, X ❑ Agent
or on the front if space permits. ❑ Addressee
1. Article Addressed to:
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D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7001 1940 0000 2240 7997
a �;•. P,�, r rn t Receip
'', .� �3'�`�^p. •��'�� .'�h k,, . - .. •- 102595-00-M-0952

Perry K. Smith
100 Waterfront Ave.
Newport NC 28570
111-1--�-14�t�'-
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIII
7001 1940 0000 2.40 7997
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UNC'LAI RETURN To SENDEED
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