37562_SMITH, ROY_20040308

C�CAMA / ❑ DREDGE & FILL / Y (Tl
GENERAL PERMIT Previous permit #
_New ❑Modification _Complete 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 I . ! ! L o
—1 Rules attached.
Applicant Name k •T SY`" i� �^ Project Location: County '
Address E ( r nP ° Street Address/ State Road/ Lot # s
Ci % i,, o'� i • State IvI ZIP J C7 ,.
ty (-,i-
Phone # (/' ) t? i Fax # () Subdivision
Authorized Agent City '� fit„ t'+ _ _ ZIP 7e.>-e
CW ElEW ® PTA El ES [IPTS Phone # ( ) River Basin V4 4 �u
Affected _ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body � • �•+a �{ � g n r a (nat �f�a /unkn)
AEC(s):
CPWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body v P I.-f L, 44 '� v✓
Type of Project/ Activity
Pier (dock) length
Platform(s)
Y
Finger pier(s)
Groin length k '�
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp -
Boathouse/ Boatlift
Beach Bulldozi
Other
(Scale: 1v cry �" )
if
�-
T
Y
I
i
_
II
j�
-
i -r -
--;-
r
Shoreline Length1—
SAM not sure yes no
Sandbags: not sure yes no
........_l..
Moratorium: n/a yes no
Photos: yes no - ! - -
Waiver Attached: yes no ---
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions ►Vt [ Y Sin a. Z J / �� a 4-11( (r �r v i r
If 4
Mlry ►"o,f r P Mo
Agent or Applicant Printed Name Permit Officer's Signature
Signature ** Please read compliance statement on back of permit Issuing Date Expiration Date
ApplicationFee(s) Check# Local Plan ningJurisdiction Rover File Name

14
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, certify that this project is consistent with 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 (910-39S-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
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)
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

ROY R. SMITH
4621 SELLIE DR.
GARNER, NC 27529
6766
66-19/530 NC
Date
405
loo,
noiia,-s
HafionsBank Advantage
NationsBank, N.A.
ro, 6-?e 22Y6 z
,
1:OS300019D: 00001130?9847i1' 6766
-- — - -- -
(.'Iar4rA ern GUARDIAMR SAFET'BLUE OEBL

AI
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent toj�li %f�s� 's
(Name of Property Owner)
property located at J eW,49 ff% Z1 PV
(Lot, Block, Road, etc.)
on l.SLa�r� , in �� lii 1K 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.
W)
It
I do not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
MAR 0 5 2004
----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be alled in b individual proposing development)
S6 ./
V
SIC_ 4.2 _ 3
BOAT ti r9
L�fT U ,I`y1LI
L �2.9
t 2.4 DOCK
F 15.0'
NF'W
Moos E-
.J'
BOA
LIFT
17.9'
'I 21.7'
ROY R SMITH
4621 SELLIE DR
GARNER NE 27529
3�
Q
------------------------------------- -----------------
'u
h Signature
rn
2 Prin or Type Name
Telephone Number
Date: Z- — 7i3 - Q y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to's
(Name of Property Owner)
property located PT '&- yal ,
(Lot, Block, Road, etc.)
on 17e �1; , in //4/VS �4>A?-0 , 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.
MAR 0 5 12-004
-----------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To_be filled in by individual proposing development)
4.2
BOAT
LIFT
a
14
12.9'
12.4
DOCK
J.2'�
L!f
H
J.1
'
o'
v
1
N
M
BOA
LIFT
17.9'
' 121.7'
ROY R SMITH
4621 SELLIE DR
GARNER NC 27529
3�
a
`t ---------- ----------- ------------------------------------
7
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u
Signature
Q
Print or Type Name
sz - .7
Telephone Number
Date: ?/ - Zi — d y