Smedley, Drew

9CAMA /,L DREDQE & FILL No. 75914 A B C D
®
GENERAL PERMIT Previous permit# ;RNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous perm' issued
As authorized by the State of North Carolina, Department of Environmental Quality / 1.�
and the Coastal Resources C mission in an are ,of environ ental concern pursuant to 15A NCAC // //// l•
// / ❑ Rut attached.
Applicant Name (➢ `� ^�'•-- Project Location: County (' r
Address A � b ✓ op"? C .i � Street Address/ State Road/�ot #(s)
City f r . �� ` / �, / Stag/( ZIP �, 5
Phone # ( ) Ma'
Authorized Agent J C/
d ecte ,AffectedCW -G3EN� PTA El ES ElPTS
AEC(
ffecte OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: ,-/91s Kno f PNA yes /
Type of Project/ Activity
Pier
Fixes
Float
Fingi
Groi
Bulk
Basil
Boat
Boat
Beac
oth,
Shor
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Phot
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A building permit may be required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions _
Agent or Applicant Printed Name /
signature " Please read compliance statement on back of permit"
Application Fee(s) Check#
❑ See note on back regarding River Basin rules.
PermitPfficee,1i Printed Name -
Sif(np u�r -
Issuing Datd EJxplra1i6n Date

I hereby certify that I own property adjacent to r P� ��^ c�c�(e: l s
/ (Name of Property O ti�
property located at %51 j3r'z-h d i y�� f�i�f�rC Is- ZS&.
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town 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 DEVELOPMEN I
(Individual proposing development must fill in description below or attach a site drawing)
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.) RECEIVED
I do wish to waive the 15' setback requirement.
I do not wish to
Print or Type Name / —r
Date
15' setback requirement.
FEB 10 2.020
(Adjacent Property Owner Infdti'rrfNMYf;
, o� u t� 15
St nature*
Print or T_Iwoype Name /1 /a
- . 1� 8
MailQ.ing AddRuYress
D
City/State/Zip
I-j-rf n �L81 s LS�Gt.n�
Telephone Number/email address
021 03120,ao
Date*
MIIQ
a5 "36M
*Valid for one calendar year after signature*
(Revised Aug. 2014)

4
DECEIVED
FEB 10 Z020
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �i � " Dcuo kS
Agent's phone #: ZS2--Z�/ - G 0-5-
Mailing Address:
I hereby certify that I own:.property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http•//www nccoastaimana_qement.netlweb/cm/staff-listinq or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.) RECEIVED
I do wish to waive the 15' setback requirement.
FEB 10 2020
I do not wish to waive the 15' setback requirement.
DCM-MHD CITY
� me
Print or Type Name /
Mailing Address
/4,zzrl-t -=s
City/State/Zip
9ZOI-tle S--6
Te ephone Number/Email Address
A/ Z2 o 2.
Date
(Riparian Property Owner Information)
Signature
Print or Type Name \\
Mailing Address
City/State2ip
TelepNon>e ITum er/ Email Address
Date
(Revised Aug. 2014)

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RECEIVED
FEB 10 2020
c F`
DCM-MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
/S/ i��a�cL, PoF—
Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: e
v* C A /(a Arm"q
at my property located at / S-/
in l fFi2i?le7T County.
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.
Print or Type NarAe
Title
Date
This certification is valid through /
RECEJVED
FEB 10 2020
DCM-MHD CITY

APPLICATION: LOCALITY: PERMIT ISSUED USING
STATIC LINE EXCEPTION?
YES ❑ NO ❑
59
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