60219_SMITH, LES_20120614

❑CAMA / DREDGE & FILL NO. 60219
GENERAL PERMIT Previous permit #
❑New ❑Modification 1Complete 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 I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP -
Phone # (-- ) — - Fax #—
Authorized Agent
Affected ❑ Cw Ew ' _i PTA ES I PTS
AEC(s): D OEA -! HHF -; IH UBA - N/A
PWS: FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length_ __
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap lengtl
avg distance offsh,
max distance offsf
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boadift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure
Sandbags: not sure
Moratorium: n/a
Photos:
Waiver Attached:
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Subdivision ----
City— ZIP_
Phone # (_ -) River Basin
Adj. Wtr. Body(nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: i >- . )
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s)
Check#
Local Planning Jurisdiction
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
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat 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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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)

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412

ADJACENT RIPARIAN PROPERTY UW- ER STATEMENT
I hereby certify that I own property adjacent to
property located at vO
(Lo
on zQ W
(Waterbody)
dame of Property Owner)
C'—f
f, Block, Road, etc.)
in� N.C.
(Town and/or County)
AppIicant's phone #: �S ���� Mailing Address: V %/ /i Q -g kE'r-
r ISo �J %y
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 property owner proposing development)
/VF,j )/IW//. cw � //
-------------------------------------------- --
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature
Bate
RECEIVED
JUN I a 2W
pCM-MHD CITY
(Riparian Property Owner Information)
l�
��. Signature
Print or Type Name
Telephone Number
Bate

ADi ACENT RIP_-k-,IRLAN PROPERTY C)Vly-,NER STATE -MEN T
I hereby certify that 1 own property adjacent to
(dame of Property Owner)
property located at
ok,VX— C77L
(Lot, Block, Road, etc.)
on 6a, Nei , in �k� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: a.20S—Mailing Address: `�%�>
�S o of /y, ,
d 7 r52
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 property owner proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Siznature Date
RECEIVED
JUN 1 1 2012
DCM-MHD CITY
(Riparian Property Owner Information)
—4:�gnature
Print or T5rpe Name
�z,JJ_SZ
Telephone Number
Date

ERIC B. ELLIS 4601
JASA M. ELLIS
205 NOTTINGHAM LN. 252-726-6775 66.30/531
MOREHEAD CITY, NC 28557 133
Date
Pay to the ,�1
Order of %�E/V a't- $ `��� , o
Dollars 8
First Citizens
Bank
For "P
1:053 1003001:00 L3 17 441378011' 0460 L