49771_SMIL, GALE_20070712

❑ CAMA / 'D DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partia R
As authorized by the State of North Carolina, Department of Environment d Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Applicant Name
Address
City State ZIP
Phone # O ' _ Fax # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
AEC(s):
❑ OEA ❑ HHF ElIH
❑ PWS: El FC:
ORW:
yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
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
Shoreline Length
SAV: not sure yes
no
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no -
Waiver Attached: yes
no -
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Previous permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
❑ Rdles ttached.
city U ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn�
Closest Maj. Wtr. Body
(Scale: )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date
Local Planningjurisdiction
Expiration Date
Rover File Name

z
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 Quality. Contact the Division of Water Quality 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
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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:
A. Sign 7L!
X L//
❑ Addressee
B. R ved (Prime dName ) C Dat)e ofgel%' ery
D. Is delivery add4ss different from item 1? F ❑ es
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
, 2r Article Number
punster tabor �ervib ,e>) ��Z N f 6 2 ]r 5 0003 6794 4963
3811, February 2004 Domestic Return Receipt 102595-02-M-1540
K1a'lrr. RITN1

.y w
CERTIFIED MAIL - RETURN RECEIPT REQUES
DIVISION OF COASTAL MANAGEMENT .JUN Z 1 2007
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION OR
h +� City DCM
Name of Individual applying for Permit: 1�-t_i r,v 1C �•
Address of Property: I t4 1 fb A o_(g=E WW 0 i Ty:-
0- A-2 ,--F-a-e-- © 0-
(Lot or Street #, Street or Road, City & County)
! hereby certify that I own property adjacent to the above referenced .property. The
individual applying for this permit has described to me as shown on the attached drawing
the development they are proposing. A description or drawing, with dimensions, should be
provided with this letter.
r� I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Coastal Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call (252)
808-2808 within 10 days of receipt of this notice. No response is considered the
same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift.or sandbags
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.
Signatu J Date / cl`Z3
rv� = (20
Print Name
J5A-1'5:;� y C
Telephone Number With Area Code /�

NOTE; THIS SURVEY IS.
EXISTING PARCEL OF
11

I�
;ERTIFIED MAIL • RETURN RECEIPT REQUE
D
'F
DIVISION OF COASTAL MANAGEMENT1_ .
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER�ORM `u�� ,� r•,'
Name of Individual applying for Permit: &I-Lsov w G-k t L1 ,:- 5
lc�i
Address of. Property: !� 1� �� s s r M 0 P- Fwe-A-A c
A f2. T- t rz C1
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described to me as shown on the attached drawing
the development they are proposing. A description or drawing, with dimensions, should be
provided with this letter.
✓� << I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Coastal Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call (252)
808-2808 within 10 days of receipt of this notice. No response is considered the
same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift.or sandbags
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.
✓l�ls l-0 // z
Signature Date
Print Name
yi q - 7,f -1�-/7J
Telephone Number With Area Code

NOTE: THIS SURVEY IS OF AN
EXISTING PARCEL OF LAND.

8131
A. K. SMY
531
G. K. SMY BRANCH/2302
P.O. BOX 1423
MOREHEAD CITY, NC 28557
$ A .
0 111
BUTT /iDVANTAGE
BRANCH BANKING AND TRUST COMPANY
1-No-BANK BBT B T.com
9n�u
i:053 10 112 0:000 1 2330 14 11311'0 13 1
r