17028_SMITH, JIMMY W_19970327

CAMA AND DREDGE AND FILL Y
GENERAL'�
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name
AAA
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
Phone Number
Zin
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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, `` n
applicant's signature
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no ,�� /✓�'
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

AM
MERE

ADJA 3T RIPARIAN• PROPERTY OWNER STATEMENT
(� I PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to r eM M � 14 f %%� 's
(Naihe of Property OW70
property located at
, Block, Road, etc.)
on Ii , in � �r , �' - �L� , N.C.
(W rbody) (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)
�e
r G� �q h
�)MI -4m a 1-VC-K�
Print or Type Name
-7 -��-y:37q
Telephone Number
Date: Y� M , ) -�' ) `(q 7

ADJACENT RIPARIAN It. _ ."-FY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own pro rty adjacent to �I-Jl m 's
� (Naof Property Owner)
property located at
(Lot, Block, Road,
/Rl oad, etc.)
on G , in (�.� .� /l� l N.C.
terbody (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)
� IK
Signature
Print or Type Name
5/5-7A-12-zg'
Telephone Number
Date: —T- / S - 7-7