19687_SMITH, PERRY_19980928

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CAMA AND DREDGE AND FILL
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
Annlinant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity _
Phone Number
Zip
PROJECT DESCRIPTION
SKETCH N.
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(SCALE: � )
Pier (dock) length
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7
Groin length
number
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Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
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Boat ramp dimensions
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Other
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,
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 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
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
attachments
application fee
U' applicant's signature
f4
issuing date
permit officer's signature
expiration date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to C e / / 7 s
(Narde of Property Owner)
property located at 1 Q (') (J).Aq &-K rynWl
;� (Lot, Block, Road, etc.)
on 1� 06 U & s�'7(.�N �� , in C/' ���� T , 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/boatEft/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.
v I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number
Date:

SENDER:
I also wish to receive the
■ Complete items 1 and/or 2 for additional services.
■ Complete items 3, 4a, and 4b.
following Services for an
g
■ Print your name and address on the reverse of this form so that we can return this
extra fee):
card to you.
■ Attach this form to the frontof the mailpiece, or on the back if space does not
1. ❑ Addressee's Address
permit.
■ Write "Return Receipt Requested" on the mailpiece below the article number.
2. ❑ Restricted Delivery
■ The Return Receipt will show to whom the article was delivered and the date
delivered.
COf1SUlt postmaster for fee.
3. Article Addressed to:
-So?
yo\z rToL-up, V �-
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4a. Article Number
2 3('
L
4b. Service Type
❑ Registerad
2-t7ertified
❑ Express Mail
❑ Insured
❑ Return Receipt for Merchandise
❑ COD
7. Date of Delivery
5. Received By: (Print Name) _ I
8. Addressee's Address (Only if requested
and fee is paid)
6. Signature: (Addressee or Agent)
X
PS Form 3811, December 1994 102595-98-13-0229 Domestic Return Receipt

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Print your name, address, and ZIP Code in this box •
PLY-f � �; � 7'
1C90 �Ai�_aw�- Av

CERTIFIED
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ercy S t
100 Waterfront Ave.Z 598 738 469
Newport, NC 28570-4510
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r. NTURN RECEIPT 0 7 yo[zr �,� �b g
UESTED
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'"''• REFUSED
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Wa"U"I D teMens-DINDRUGN1 _ 1
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: &s �r
Address of Property: 100 F P 0,1V % AV
JO
(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, Hestron Plaza II, 151-B, Hwy. 24, 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.
Signature Date
Print Name
Telephone Number With Area Code

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