Smith, Jay

r CAMA / DREDGE & FILL A B C D
GENERAL PERMIT Previous permit #
CINew EModification ❑Complete Reissue Z�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 I SA NCAC
Rules attached.
Applicant Name Project Location: County4
Address Street Address/ State Road/ Lot #(s)
City_ State ZIP --
Phone # (_) E-Mail Subdivision
Authorized Agent City_ ZIP_ _
El CW JEW E PTA DES C PTS Phone # ( _) Rver Basin
Affected cw
O HHF C IH ❑ UBA � N/A ' i�
AEC s : Adj. Wtr. Body ,r r "� f ", Hat '/man /unkn
F
D Pws. Closest Maj. Wtr. Body
ORW: ves / no PNA yes / no
Type of Project/ Activity
Pier (dock) length /
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bul
Other
Shoreline Length
SAV: not sure yes no , —
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
t
(Scale:
l )
M-See note on back regarding River Basin rules.
Permit Officer's Printed Name
t
Signature ** Please read compliance statement on back of permit Signature
Application Fee(s)
Check # Issuing Date Expiration Date

Statement of Compliance and Consistency T
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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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)
http://www.nccoastalmanagement.net/
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)
Revised 08/27/ 14

From: Jx Saw IM [e-mail] ;
Subject: kw. dock P10*1
Date: Apd 7, 20tS. & #I.4*ak
To: tlrwtc6Robwjr on [e-mail]
.... ......... .
You nave my oermission. and oiease Keeo
i nanK %x:.
Sent from my ir'riw,
On Apr 5, 2018, at 2:58 PM, Brandi Robertson <brandiprobertson(Lb gmail. com> wrote:
Dear Mr.Smith,
I have sent Notification Forms to your neighbors about the proposed project, which is part of the permitting process with the State. As soon
as I get those signed forms back in the mail I will set up an appointment for a site visit with Mr. Connell with the Division of Coastal
Management.
In the event that you are not available to meet with us on site I would like to get permission to act as your Authorized Agent. This will allow
me to obtain the permit on your behalf.
Please respond to this email confirming that I have permission to act as your Authorized Agent.
Thank you and I will be in touch.
Brandi Prescott Robertson
B Prescott Marine Construction, LLC
252-249-0149
[e-mail]

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to �,� �y Sm ( + 1 's
MUD
J,� M.
me of Property Owner)
property located at lt� OV 5m f Tr ► Fafy � Mi
/� i (��� c���i�, (Address, l�qt, Bloc�C, Road, e�
(_� I�l�(}� 1�.)
on - , in }-}61 VP I nC n C-61 , N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(7Wffv dual proposing deve%prnent must M in description below or aKach a site drawing)
C c� P y
rc'� wz-
suaa- P clf�4y"
5x I D- S4ef(4 wn
4C �e
�✓ rv+y
WAIVER SEC ON
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.
L do not wish to waive the 15' setback requirement.
(Property Owner information)
Signature
Print or Type Name
Mailing Address
Crly/StatwDp
Telephone Number/email address
Dare
'Valid fior one calendar year after signature'
(Adjacent roperty Owner inkmmtion) )
Print or Type
Maili ddress
C;ty/s zS� :a 2-1A
.
Telephone Number/emaff addniss
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t� Goi -4M ( +r ' I
I Ve of Property Owner)
property located at l� ; >�i1 f �1� , Em-M
on bi(n� (Address, 49t, Bloc , Road, e )
- Cif C�ee1C , in I JeA�l2 �(1ClE I(Ot�,)f ' -- , N-C.
(Waterbody) (CityrTown 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.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
C
SX I o - S-����la►�,�
Prop�r�y
=Pry}peg+y
R(C l e
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date
'Valid for one calendar year after signature"
( 'cent Property Owner Info)
Si lure * �j
�an� � i3r�sh
PrinsType Name
0O LISa
nFriYgAddress NL 2 -7 s (a c1
City/State/Zip '
pia �tqt,- 2xa5 /mo►mo�� gaol
TelephonMrr_�9mbil addressDate*
(Revised Aug. 2014)