25543_WOODFIN, FRED; J T SMITH_20000501

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Applicant Name
Address
�0
CAMA and DREDGE AND FILL ,
G E N E R A L � 25543
;.i
PERM I I Z
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 15 NCAC
City
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
fBoat ramp dimensions
I other
State
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project 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.
Phone Number
zip
(SCALE:
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

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04;'10.00 MON 11:40 FAl 910 326 8406 .J_T- & Sherry Smith Z001
ADJACENT R PARlAN PROPERTY OWNER STATEMnENT
(FOR A PIERIMOOR7IVG PJMGS/B0AIZIFT/B4A?7IOIlSE)
I hereby certify that I own property adjacent to ,s
// (Name of Property Owner)
Property located at beZ
on
(Waterbody)
(I.ot, Rio&, 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 has proposal. I understand that a pierlmooring
pftingsrboadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
Of rlpa-dan access unless waived by me.
I do not wish to waive the setback requft rent.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be jWed in by individual proposing development)
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►mot-,�i�s " �,,r _ , ,. o.-
Print or 1Mx Name
Telephone Number
Date; — 4 O

NC H0UHRIU1VPK. Fax: 1-215 -_V-0663 Hpr 2� '00 10 56 P. CJ1f01
tilvJrit.L' i� JL xW caa---AL .. iw. a..ft.— .. , , . _.---
(FOR A PIER/MOO)ING PILINGSBOAT ITIROATHME)
I hereby certify that I own property adjacent to CA-"
(Name
(Name of Property Owner)
property located at
(Lat, Block, Road, etc.)
_ y� i� � J fl N.C.
on in ,
aterbody) (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/boadiftlboathouse 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 #o wish to waive that setback requirement.
DESCRI MON AND/OR DRAWING OF PROPOSED DEVELOP21-=.-
(To be filled in by individual proposing development)
r/•
.4
Print or Type Name
Telephone Number
Date: