Smedley, Drew

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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
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)
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit.
The Local Permit Officer will help you, if requested.
PHYSICAL DIMENSIONS
Labelroads
Label highways right-of-ways
_ Label local setback lines
Label any and all structures and driveways currently existing on property
Label adjacent waterbody
PHYSICAL CHARACTERISTICS
Draw and label normal high water line (contact LPO for assistance)
Draw location of on -site wastewater system
If you will be working in the ocean hazard area:
Draw and label dune ridges (include spot elevations)
_ Draw and label toe of dunes
Identify and locate first line of stable vegetation (contact LPO for assistance)
Draw and label erosion setback line (contact LPO for assistance)
Draw and label topographical features (optional)
If you will be working in a coastal shoreline area:
Show the roof overhang as a dotted line around the structure
Draw and label landward limit ofAEC
Draw and label all wetland lines (contact LPO for assistance)
Draw and label the 30-foot buffer line
DEVELOPMENT PLANS
Draw and label all proposed structures
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Draw and label areas that will be disturbed and/or landscap�
Note depth to be in
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size of piling and placed ground
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Draw label be
and all areas to paved or graveled ` /
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Show all areas to be disturbed L
Show landscaping
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NOTE TO APPLICANT
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Have you: T dp
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• completed all blanks and/or indicated if not applicable?
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• notified and listed adjacent Q o
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property owners?
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• included your site drawing? /1 �!
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• signed and dated the application?
• enclosed the $100.00 fee?
• completed an AEC Hazard Notice, if necessary? (Must be signed the property owner)
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APPLICATION FOR
N. LAMA MINOR z
Coastal Management DEVELOPMENT
ENVIRONMENTAL QUALITY PERMIT
In 1974, the North Carolina General Assembly passed the Coastal Area Management Act V ,
(LAMA) and set the stage for guiding development in fragile and productive areas that
border the state's sounds and oceanfront. Along with requiring special care by those who
build and develop, the General Assembly directed the Coastal Resources Commission
(CRC) to implement clear regulations that minimize the burden on the applicant.
This application for a minor development permit under CAMA is part of the
Commission's effort to meet the spirit and intent of the General Assembly. It has been
designed to be straightforward and require no more time or effort than necessary from
the applicant. Please go over this folder with the Local Permit Officer (LPO) for the
locality in which you plan to build to be certain that you understand what information he
or she needs before you apply. a
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Under CAMA regulations, the minor permit is to be issued within 25 days once a qG
complete application is in hand. Often less time is needed if the project is simple. The
process generally takes about 18 days. You can speed the approval process by making
certain that your application is complete and signed, that your drawing meets the (U)
specifications given inside and that your application fee is attached.
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Other permits are sometimes required for development in the coastal area. While these n
are not CAMA-related, we urge you to check with the Local Permit Officer to determine
which of these you may need. A list is included on page two of this folder. ..1
We appreciate your cooperation with the North Carolina Coastal Management Program
and your willingness to build in a way that protects the resources of our beautiful and t^ D
productive coast.
Coastal Resources Commission
Division of Coastal Management
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DCM Forth EB1952-2015/Revised

Locality Permit Number
Ocean Hazard Estuarine Shoreline ` ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER - M� AILING ADDRESS
Name D //5 � oy
Address O y�C�t�t/ ;)y LegLIiIT/t�
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City �G tt 0 r StateJ / v Zip a_7 ' hone
Email jASVVII&CJ Qri/14• /• fO"U�
AUTHORIZED AGENT
Name k S
Address '57 0 Z&'A'i v e w �Jr
City / //U{/'S J'r14,-XState /0 C Zip; p�Whone ZS Z — Z V / —
Email
LOCATION OF PROJECT. (Address, street name and/or directions to site; name of the adjacent waterbody.)
15 ( i3✓'G�� 0 /` if 1i9-n of /) C
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
>C_A_ i-- *3"R i Gs �nJ )%�ciS oil
SIZE OF LOT/PARCEL: square feet acres
PROPOSED USE: Residential ff"' (Single-family Multi -family ❑ ) Commercial/Industrial Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ifyou are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet (includes the area of the foundation of all buildings, driveways, cov decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the pro_ awing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a Stte` ,
Stonnwater Management Permit issued by the NC Division of Energy, Mineral and Land Resources (DE*9 n
YES NOZ
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: sgzfeet. F..�
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OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
P an owner or record title, Title is vested in name of ��� �s� ^ e-
see Deed Book 4ES:page y 7L in the C—AK 3Z'/e T County Registry of Deeds
_an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in
County.
_if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)) /
(I)�tftSAi/70Vf•{ur^f Ltw;s /4/7 piAyrc�
(2) Gr`0✓6nn; Ga c c v le s— tat• e'yA x7r
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application. I J
This the 16 4 day of c.w20
or person authYrized to act as his/her agent for purpole of filing a CAMA permit application
This application includes: general information (this form), a situ drawing as described on the back of this application, the
ownership sto err nt, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and
any inform a' may be provideNnlly by the applicant. The details of the application as described by these sources are
Mncorporated ut reference in ermit which may be issued. Deviation from these details will constitute a violation of
ping
Mny permit. A rson d�50
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AEC without permit is subject to civil, criminal and administrative action.
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RECEIVED
JAN 3 0 2017
DCM- MHD CITY
RECEIVED
JAN 18 2017
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I ownproperty adjacent to rP.t� Srn(e- DNS' 's
(Name of Property. Owner)
property located at —40 Fre-Awa . ;
on e^ CrPk 'A , YJor' h UU-A�ddress, Lot, Block Road, etc.)
in .SC-- , N.C.
(WAterbody) (Cityf own and/or County)
The applicant has described to me,. as shown below, the. development proposed at the 'above.
location.
I have no objection to ..this proposal.
have objections to this proposal...
pESCR.IPTION :AND
##dividuai proposing deVelopr
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❑n1.1Y.q'111%%X V. r rrivrVacu UGVCLVCIVIGIY 1
must fiff in description below or attach a site drawing)
RECESVED
JAN 3 0 2017
DCM- MHD CITY RECEIVED '
JAN 18,2017
WAIVER SECTION
I understand ti nt, a pier, dock, mooring pilings, :breakyvater, boathouse; lift, or gpip ist C ITy.
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back:a minimum distance Of1S from my: area of riparian access unless waived by me. (If you
wish to waive .the setback, you must Initial the. appropriate blank below.)
do wish .to waive *615' setback requirement. ,
do not wish to waive the 15setback requirement.
rope 0 er In ion) (AdjAcorit Property Owner Information)
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a atur r Si `.ature
Print or Type Name P int.or Type Na e
_15-12. t e-6v,,
ole-
M Addre s iiin Address
��t o .NC .27-7
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City%State/ p CitylState/Zip
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17-
Telephone Number Telephone Number
Date Date
(Revised 6/18/20M2)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own. property adjacent to
JAN 3 0 ZU1/
®CM- MHD CITE
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RECEA'
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JAN 152017
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WAIVER SECTION .
I understand that a 'pler, dock, hioonng pilings, breakwater, boathouse, lift, or grol� 6e D. C1
'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.)
do isih to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
operty 0 ner 111 ion) (Adjacent;P�rtyOwner Information).
tuYe Signature' .
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Print or Type Name Print.or Type Name +j
�ffllngA�ddress Mailing Address
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Crt Stafe �p CityfState/Zip
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Telephone Number Telephone Number
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Date Date
(Revised 6/18/20t2)
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