36713_SMITH, LEWIS_20031201

P til
n CAMA / C DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New -Modification ClComplete 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
(] Rules attached.
Applicant Name,, ; .; i '- Project Location: County,_ -
Address _ iJ ;. (_ ,, Street Address/ State Road/ Lot # s
City l ',_. State ZIP
Phone # O Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected `— CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑' HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity _ .y
Pier (dock) length
—T�
Platform(s) ,
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift —N .�
Beach Bulldozing
Other
1
11
t
vi y' , --
Shoreline Length t
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes ho
Photos: es no
Waiver Attached: yes no
A building permit may be required by: �•
Notes/ Special Conditions
ni.�- 5 L
Agent or Applicant Printed Name `Jl
Signature Please read compliance statement on back of permit
(Scale:
f t .
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
g Date
Expirition Date
Rover File Name
ApplicationFee(s) Check# Local Plan ningJurisdiction

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:
El 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

JAMES L. SMITH
THE PATRICIA D. SMITH
G lden C' ie
1034
o irc SPECIAL ACCOUNT 6-7704/2531
\\ y/ BU NER, ST. 27 919-575-6092 (��
v BUTNER, NC 27509 y
Date
Pay to the
Order of _1, l
State Employees' Credit Union
-oar,
11 Butner, North Carolina
For621f-3(/O7Z, C(EwiS SA4'1I
4. ._...
II' 0 3 4
is 2S3 1770491:08630393 27 1
$ jrc.e,�
',/�o Dollars

ADJACENT RIPARIAN PROPERTY OWNER STATEMMNr
(FOR A PIERIMOORING PIIINGSIROATLIFTIBOATIIOUSE)
10A9�ov(
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at f Jd,,v
(Lot, Block, Road, etc.)
on (� Q:� % x 's C /� Y , in w r+ti� `J a h , 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 dq wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
N=Y�.7G���Y�.wZ0'J
GeJf (i
Print Name
ci(O
Telephone Number
Date: l J / 63

ADJACENT RIPARIAN PROPERTY OWNER grATEMENT
(FOR A PIERIMOORING MUNGSIBOAMPrIBOATHOUSE)
I hereby certify that I own property adjacent to L/ t-3 D) �✓ I s a
(Name of Property Owner)
property located at �� z�r}C-�1� J- v� Et •
(I.ot, Block, Road, etc.)
N.C.
on J=o s 1 ,=n- s LpP,P- K , in � :;� ��%s �,
(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/boadift/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.
V1 I dQ wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
_
print or Type Name
Telephone Number
inter ' ( - ( 7 — C)