Smith, Isaiah

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NERAL PERMIT Previous permit#
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❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �` /J `�` �/
and the Coastal Resources Commissioniin an area of nvironmental concern pursuant to I SA NCAC V
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Isaiah L. Smith ,s
(Name of Property Owner)
property located at 2962 Cedar Island Rd
(Address, Lot, Block, Road, etc.)
on Cedar Island Bay in Cedar Island N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I
7� I have no objection to this proposal.
\, I have objections to this proposal.
F DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
(See attached drawing for maintenance of existing boat basin and channel.)
WAIVER SECTION
understand that a pier, dock, mooring pilings, 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+'4�do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Isaiah L. Smith
Print or Type Name
2963 Cedar Island Rd
Mailing Address
Cedar Island, NC 28520
City/State/Zip
Telephone Number
02/13/2020
Date
(Adjacent Property Owner Information)
j� �
0171
Signatur• /VI
Gary P. and Maxine Day
Print or Type Name
2978 Cedar Island Rd
Mailing Address
Cedar Island. NC 28520
City/State,,Zip
Telephon Number
Date
(Revised 6/1 &2012)

AGENCY AUTHORIZATION
I, Isaiah L. Smith, do hereby authorize Gary Mitchell to act as my agent in any and all transactions,
communications and interactions, as
deemed necessary, with all federal and state regulatory agencies regarding the property located
at 2962 CEDAR ISLAND RD, Cedar Island, in Carteret County, NC and as described in the Carteret
County GIS PIN 840602554005000.
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Signed: -..501icL i. 1SryV111I I-10
Date:_��/
(N0181763.DOCX; 1}

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