21060_SMITH, THOMAS & SMITH, DEREK_19981120

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CAMA AND DREDGE AND FILL
GENERAL N104F 060
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 Phone Number
Address
City State Zip -
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards i
Boat ramp dimensions
Other
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This permit is subject to compliance with this application, site
rX
drawing and attached general and specific conditions. Any
/ .-
violation of these terms may subject the permittee to a fine,
applicant's signature
imprisonment or civil action; and may cause the permit to be-
Q-'
�\
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.
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The applicant certifies by signing this permit that 1) this pro-
t ��
ject is consistent with the local land use plan and all local
i ing 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.

DEREK S. SMITH
NC 7836496 PH 919-247-4428
107 HAWTHORNE DR
PINE KNOLL SHORES, NC 28512
PAYDER TO
ORTHE OF
Wachovia Bank of North Carolina, N.A.
Morehead City, NC 28557
FOR 13of IkX bCeb
1:0 5 3 10 L 5 2ql: S L, C3 L L L 3 2 LL 1 37
0 14AM ANO
1437
0 66-152/531
$
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ADJACENT RfPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLlFI/BOATHOUSE)
I hereby certify that town property 4ac ent to , c rr, «.s , , 's
(Name of Property Owner)
property located at
(Lot
`� �Y
on l� S C C J C_ i e c T�
-1
(WaLerbody)
Block, Road, etc.)
in
(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 dW a pier/mooring4s0'-/, "Ji
pilings/boadiftAmathouse must be set back a minimum distance of fifteen feet (151) from my area
of riparian access unless waived by me.
I do got wish to waive the setback requirement.
�! I dg wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be,lllsd is by individual proposing development)
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J[LmtrS 0. T01A.1son
Print or Type Name
Telephone Number
Date: fz/z`2%
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- ADJACENT RIPAR AN PROPERTY OWNER STATENIENT
(FOR A PIERIMOORING PILINGSIBOAlUFT/BOATHOUSE)
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at _ 7 i Pe m; -.i a r C,_,�
(Lot, Block, Road, etc.)
on
N.C.
(Waterbody) (To 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/boadiftfboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
,s I do. not wish to waive the setback requirement.
1/ I dg wish to waive that setback requirement.
DESCREMON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be JWed in by individual proposing development)
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G�
Signature
el? 4',,,/ l?.
Print or Type Name
Telephone Number >
Date:

Location: Field Rep.
Phone: —J Date of Report:
Description of Project:
Date Proj ect Reportedly Complffete :
(1)- Do the measured dimensions of the devel differ from those
indicated in the permit .and kplat?, Yes / No Have all per -,-,it
conditions been satisfied? Yes No '
COY-MENT : .
(2) SEdi uentatiOn an(i Erosion Control Has pErTii1 - = scE�E CrasSE��
Or GtIlEr-wlsc sta*,i 1 i ZE^_ all disturbe^ arEas' YE NO r
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CO2�'�NT :
(3) Future Mcn i tcrinc and 7nforce-gent P_ i
or enforcement action needed? YES � O
COMMENT:
r
I_= fL'rther investigation