54386_SMITH, BILLY_20090923

Applicant Name v
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Street Address/ State Road/ Lot #(s)
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A building permit may be required by:
Notes/ Special Conditions
�
See ""rp.�n River Basin r�eo U
/netime period requirement for this '
2--_' Authorized development >ssuspendec �
until December 31,ZO1CLpursuant tothe 'Permit Extension Act of 2009.
�
�
Per
,TiyOfficer'� Signature
Local PlanningJ U*risdiction 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, certifythatthis project is consistentwith 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/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

MONITORING & COMPLETION REPORT
(CAMA Major Development & State Dredge & Fill Permits]
GY /
,f
PERMITTEE'S NAME: S
LOCATION:
PERMIT #
FIELD REP.
6C
'' V - 1 UMONITORED BY
PHONE: 0 ,� DATE REPORTEDLY COMPLETE: / 1
DATE OF INSPECTION
1) Do theasured dimensions of the development differ from those indicated in the permit and workplat?
VFV/N(T 6-irrin nnnl
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle/Sne]
3)
COMMENT:
FUTURE MO ORING & ENFORCEMENT ACTION
needed? YES O circle one].
COMMENT. © t \
Is further investigation or enforcement action
e �Je

North Carolina bepartmen�©ironment and Natural� "ED
!� �. :
Division of Coastal Management
Michad F. EaMey, Govorr►vr Charles S. Jones, ©hector 9 2009
WiMarn `Foss Jr.. secretary
Morehead City DCM
Applicant Name
Mailing Address 2-11 f 6
I certify, that I have authorized (,ggent) fflpt�?�G S7Z"L L,
--...r..� to act on My
belialf, For the purpose of applying for and Obtaining all CANIA Peratits necessary to
r r �
install or construct (activity) I/ �( l Z- l —11 -1xe -- P e, �2 l -Z
at (location) - 7—
This certification is valid thru _ `�' / O
Signature
400 Commerce Avenue, Morehead City, North Carolina 285J7
Phone; 252-808-28081 FAX [phone] lWemet; WWW.nccoaitalmanagemont.net
Qn Frn,nl-lnnnrhinifi,1 hf$rmOltvG Ao inn FmnjnvPr-.rj(1%Racw-larf1'A P ns;f hnnunmAr Pannr

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
{ (FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
--
I hereby certify that I own property adjacent to ' 1
1,1
(Name of Property Owner o cant)
Mailing address if different from location address 7165/01-0 a�, SEP
9 Z009
(town, state and zip)
phone numbers you can be reached at 252 —
property located at 21 / CS�
(Lot, Block, Road, etc.)
on SDi1.� 1< </QY , in - (:fN.C.
(Waterbody) (Town and/o 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.
initials
I do wish to waive that setback requirement.
initials
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�'%A ce .�
-------------------------------------------------------------
I
SignaLw
Print or Type Name
3S a- D4-7-43L--%'
Telephone Number
CM
�¢dg'resS

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Narne of Property Owner o
Mailingaddress if different from location address 2l� S '7 A0
,
(town, state and zip) �� i� A/ C, 2��! 00,FP 9 2009
2-sZ - sd
phone numbers you can be reached at �DCM _ `l� " Z
property located at _ 2 �� Tos
--1
(Lot, Block, Road, etc.)
on Eolak 41'vel,- , in N.C.
(Waterbody) (Town a 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.
initials
I do wish to waive that setback requirement.
initials
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f lled in b individual proposing development)
J VJ S .
Inc,
rVr/ �e- D
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----------------------- ------------- --- - --
L
Signatu,:
aJ A)��
Print or Type ame
Cr 10 - 07 516L4
Telephone Number
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V 7316
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Rogue Banks Marine Construction, Inc. 12106
111-D Turner's Dairy Rd
Morehead City MC 28557
252.267-4428
WACHOVIA BANK, NA
66-021 /530
6903
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PAY TO THE
ORDER OF
DOLLARS
Vt
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