25686_COATS, ROB; J T SMITH_20000614

CAMA and DREDGE AND FILL 25F86
D C D EAA 1 T ff ,
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
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROTECT DESCRIPTION SKETCH'
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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
issuing date
(SCALE:
applicant's signature
permit officer's signature
expiration date
attachments
application fee

ThJ"IGHT WAY
C" J. T. SMITH �
T CHAADIETN . SMITH
228 SUNSET DRIVE _'52-393-7883
jV SWANSB RO, N( 28584
PAYGJ-
ORDER
RDER Ett OFF -
66-85/531 1531
0282027235
DATE ..- a
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: -Al -'s
Address of Property:
EA
I hereby certify that I own property adjacent to the above referenced property. The individual
an 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.
—LA? I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestrun Plata 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 notiled 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.
4 _e-e
elignt�tune Date
Print Name
Telephone Number With Area Code

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOAMFl/BOATHOUSE)
I hereby certify that I own property adjacent to's
(Name of Property Owner)
property located at amSa,(1,5 A) p op
-
(Lot, Block, Road, etc.)
on &��' �D1�44L , � �_ �� ►� ���,� %i ��'w '— 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/boadiftfboathouse 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 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIERW:
(To be filled in by individual proposing development)
Sighature
Print or Type Name
Telephone Number
Date: —:? - ��Z

,fWi Auj'Iy Y JLU I "UU ll i 1 Jb QUA IJx s a .A. ti.r
(TOR A PIER/MOORING PILINGS/BOATLIT'T/BOATHOUSE)
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I hereby certify that I own property adjacent to + ,IT s
(Name of Property Owner)
(Lot, Block, Road, etc.)
in �Vj
(Town and/or bounty)
He has described to me, as shown below, the development he is proposing at that
ation, and, I have no objections to his proposal. I understand that a pier/mooring
ings/boadift/boathouse must be set back a minimum distance of fitteen feet (15') from my area
riparian access unless waived by me.
I do net ;dish to waive the setback requirement.
p( I do wish to waive that setback requirement.
DESCRIPTION .AND/OR DRAWING OF PROPOSEDDEVELOPMENT:
(To be filled in by individual proposing development)
PINI s°,cam s
1 `7'
signaiure
Print or Type Name
Telephone Number
Date:
f �I s!Y.

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