59377_SMITH, WILLIAM_20111107

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous p ermit #
❑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
n Rules attached_
Applicant Name
Address`
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t}t.da t' "� r� • is
City :s`!:
jjta
�t�C. s State't ZIP 2J�'7�
Phone # ()
Fax # ()
Authorized Agent
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64 ;
Affected ❑ CW
0 EW M PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City r 1 7 �w,cl ZIP
Phone # ( ) "? 4 I. i (3; 2 River Basin
1
Adj. Wtr. Body ?P #;� (nat man /unkn)
Closest Maj. Wtr. Body3 `
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
1 l -f i at C j 3C1 E t
Issuing qate Expiration Date
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
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
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

CHARLES B. BROOKS NCDL 3941936 1815
DONNETTA BROOKS NCDL 3229376
507 BAYVIEW DRIVE / PH. 252-728-6886 , 66-1246/531
HARKERS ISLAND, NC 28531 ATE
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BORDER QF I
LI�z- CJ T //C) i J � LLARS L'1Fs-
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ank Sound AdVamage
Beaufort, NC 28516FO
l:053 i 1 24661: 00075770"8 IBIS
Sh
s

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to fjj/, 's
(Name of Property Owner)
property located at �,4U 1/, 6--'Al B,< ,
(Lot, Block, Road, etc.)
on 9,4�y , in &,dews (CIA 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
Z-� I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developrnent)
DN e 8().4--� /. i'f --�- w -/-/I SIV4// % /-¢
------------------------------------------------------------------------------- -- -- --------------
Sig ature
ItECEIVED �!r/y/l�vG � - E�IiC�•'��
hov 0 3 Z611 Print or Type Name
DCM-MHDCrfv Telephone Number ,
Date: - /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to W lA.-A ," 6. 5;211 '.71- 1A 's
(Name of Property Owner)
property located at
Block, Road, etc.)
in 6 4xke e5 T�-1417d LC,4,e c-f CGY,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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�.Fo,4 6--ni 4 lJ 14 4-pr0 oC P1
----------------------------------------------------------------------------- - ---- ------------------------
ignature
RECEIVED
NOV 0 3 2011 Print or Type Nadie
DCM-MFiD CITY g�q -
Telephone Number
Date: ©, -)- 6 --- d

APR-16-2010 09:34 From:DCM MHDCTY
To:95044744 Paee:111
A�;Aqr
WDENK
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perriue, Governor James H. Gregson, Director bee Freeman. Secretary
Date / ®r 2 CP -- /
Applicant Name , ; .
Mailing Address/ eS
X certify that I have authorized (agent) 10 1 i �7 - 2 ,L ,Z to act on my
behalf, for the purpose of applying for and obtaining; all CAMAS Permits necessary to
install or construct (activity)
at (location)
C 4K cede-f eV)
This certification is valid thru (date)
Signature
RECEIVED
NOV 0 3 2011
DCM-MHD CITY
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.nel
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