Untitled

CAMA / ❑ DREDGE &. FILL, No. 74231 A B C
GENERAL PERMIT Previous permit #
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Q 7 1-1 . 12 0 O
❑ Rules attached.
Applicant Name &�^,&N .�M Irm
C Address J 12 A V15^/ST
City dC EAM ::r5G£ F 4tate \/C ZIP -'2 S'f& `(
Project Location: County g R k&l5-" Ic iK
Street Address/ State Road/ Lot #(s)
GRAVI- J S-M1, r
Phone # (-— E-Mail Subdivision
Agent Ci
Ag 1ti ty O c., / AI XJ � U aura ZIP 2 X 4-L `1 Authorized J �+E L t, 3 s
Affected [ICW
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WPTA ❑ ES 1-1PTs
A c t� , Phone # (f l 10) S4 0 - 04 10 River Basin L n
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body A I W O (n /unkn)
❑ PWS:
A W W19
ORW: yes /
PNA
yes /
Closest Maj. Wtr. Body
Type of Project/ Activity Rr-M 0 V F 9 ❑A-T tr i c -r . L./s- ; .4c t� R A at P ul rN
F OAZI,e l -D y c K (Scale:
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Fixe
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orium: yes no
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ps: yes 49
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A building permit maybe required by: QGSA AJ T-i5 t,l5— Sr—ACA ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions D r% k . 1 2-oy A -oy ,A LC, OTIA rLM Lo CA tr, S i i4-rr— ;
A ,J D F F,o'_Ir - A L Ri5 4r-v t^ LAri o A&-
,� �t9 / zel�- ZK61:5 �
Agent o Applicant Printed Name
,Sfg ture Please read compliance statement on back of permit"
UU -0-- 256c.12 5,1371
Application Fee(s)—ehr&-w
M O AX y C->TA.M P-
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Permit Officer's Pryited Name
/41 �i -e,'
Signature
4126 Rf5 o
Issuing Date Expiration -Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Brian D. Smith
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized Joel Klass
68 Craven St.
Ocean Isle Beach, NC 28469
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: removal of boat lift & insal► floating dock & ramp
at my property located at 1 Craven St
in Brunswick
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.
Property Owner Information:
Signature
/J 1-1,61 A' / l
Print or Type Name
Title
Y/ /s' / %?"
Date
This certification is valid through __4__/// Z'

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: Brian D. Smith
Address of Property: 1 Craven St. Ocean Isle Beach Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Agent's phone #:
[phone]
Mailing Address: PO Box 279
Supply, NC 28462
1 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.
-,.4-�/ 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 athttp://www.nccoastaimana_qemenLnetlweblcmlstaff-listin or by calling 1-888-4RCOAS T.
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Brian D. Smith
Print or Type Name
68 Craven St.
Mailing Address
Ocean Isle Beach, NC 28469
City/StatelZip
Telephone Numberl Email Address
Date
(Riparian Property Owner Information)
Signature
David L. . Bodenhamer
Print or Type Name
•Yito] VATLC . - e ,
Mailing Address
Atlanta, GA 30327-4757
City/StatelZip
`/I `t .3--t3-35>-3 114 h 5%S9o.s.c4.-A
Telephone Number/Email Address
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to Brian D. Smith
's
property located at 1 Craven St (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on ICVWV , in Ocean Isle/Brunswick N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat'
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill 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.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Brian D. Smith
Print or Type Name
68 Craven St.
Mailing Address
Ocean Isle Beach, NC 28469
City/State2ip
Telephone Number/email address
Date
Prooro�p? vner Information)
Sig#rature *
Garth E. McGillewie
Print or Type Name
t. t M,u.l A-e- C,-�-
Matling Address
32 WPt)cH�h,J
TelepCChone lyurnbqrlernad address
�7
Date
*Valid for one calendar year after signature* (Revised Aug. 2014)

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Date Recurred
Data Deposited
Check From Nsme
Name o/ Permit Holder
Vendor
Check Numfw
Chock
amount
Permit NumbwlComments
Necel t or iWtmdAMfioot9d
ColumM
Co1lrmn2
Coltmm3
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