Smith, Doug

A A / JREDGE & FILot'L, Nb','611�5. ,
53'E ERAL,I PERMIT roviqus permit
#
ew EModification ' Complete Reissue ElPartial Reissue Date previews permit issued`'
Ass
and
Affected ❑ CW W +il-"A p ES ElPTS
AEC(s): ❑ OEA ❑ HHF ❑1H ❑ UBA ❑ N/A
❑ PWS: ❑ FQ
ORW: yes /& PNA yes / o Crit.Hab. yes / no
[Type of Project/ Activity '� r 7
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead Riprap length
distance offshore
max distance offshore Z
Basin, channel
cubic yards
s Boat ramp
Boathouse/ Boatlift
R
Beach Bulldozing
Other '.
Sfioreline ;L
AY ,
per;
S�ndbagsy;
aTloratdr`,iurr
Body Wtr. Ad'. COO "1 � u � `
i y % ..+yam: o, (nat as /unkn)
Closest Maj. Wtr. Body
(Scale: ,� )
j __
"�' +c"t("k
A building permit may be -re ired by- ❑ See note on back regarding River Basin rules.
Notes/ Special Condifions � •�tv . l�- ��,,. +., s ,r . C r. ,.i' 1 ,. l t 4 c �+ s✓# ,
tI
AM

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, certifythat 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
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 -below New River Inlet- and
Pender Counties)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to DOu .4 4,rL S�-) ikh 's
(Na e of Property Owner)
located at l 1 l Zo cilen cc �4Y c��
on C-ona I
(Waterbody)
(Lot, Block, road, etc.)
in tqf f 14 c -BeAc�
(Town and/or County)
N.c.
Applicant's phone #: CA to -�i�d � � (P Mailing Address: 16a s toi, ►' ril e
GoIa. baro, ANC- a-7,5 -36
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
1
7S-
d .
(Information for Property Owner Applying
for Permit)
( Da Sus o, n
Mailing Address
&o 1J5 ba f'Q', N c— a 3�
City/State/Zip
;Telephone Numbe
Signature Date
(Riparian Property Owner Information)
U cSignature
9/e"g
PrintorT pee Name
Telephone Number
17-1
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
o►t iclA 's
of Property Owner)
property located at 1 I rA-B D W E W 'j *7ZS-2 t
(Lot, Block, Road, a#L) -
on LGtjct k , in-�-IANFTtAC-4 _ __-, N.C.
(Waterbody) (Town and/or County)
Applicant's phone # `a 0l) 40%Mailing Address: 107- siJSAN e,1QC.i�__-
Gol_"DS'V'.o2o'r,\G 0
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
7s'
sea-
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
J UD ' to sat"[ Cl 12 C 1,(E.
Mailing Address Signature
1'1el l T ow s
City/State/Zip Print or Type Name
222- U0q
Number Telephone Number
a -
Date Date