76189D - Smith

1-15 149UVt) 1�711►Y iw
--. AMA / ' DREDGE &-FILL NO. 76189 A B C
ENERAL PERMIT Previous permit #
lew , ❑Modification []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
❑ Rules attached.
Applicant Name C J C j �< M •^ CID i^�
Project Location: County-+�5,•.'�L�
Address % ;, �� �t rs a . F(`,rf"f Street Address/ State Road/ Lot #(s) '-� (/2
City A State AI C ZIP Z 7-S6 I
Phone # (C) O -4 Subdivision
Authorized Agent c i it City �' P�� `� ZIP 2�`� to —
Affected ❑ CW �W �A [I ES ElPTS Phone # ( ) River Basin L, �- 6e /
AEC(s): EloEA a HHF ❑ IH ❑ UBA El N/A Adj. Wtr. Body I W
man unkn
El PWS: w
ORW: yes / P­NA yes /*9— Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length (p V T)
Fixed Platform(s) I 16Y20
Floating Platform(s) C X (V
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathou oatli 2 1
Beach Bulldozing
Other
Qn t
Shoreline Length
SAV: not sure yes, 43
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdicti `
Notes/ Special Conditions N 12 -K C,-,-,
A :I Co., as R U SP F b k c k
aWNW
Sign u `'lease regdcompliance statement on back of permit **
4a Oo �ao
Appl tion Fee(s) Check #
b,1
(Scale: N l S )
❑ See note on back regarding River Basin rules.
, k\o C-A t ,—e o/
Perr9i 's Pri ted Name
s
Signatur
3 .2v 12 2a
Issuing ate If Expiration Date

3/23/2020
Mail - Brock, Brendan O - Outlook
CENT RIPARIAN PROPERTY OWNER$T
I hereby certify that I own property adjacent to Ja L ILL 114-c A" S;011 4— s
/ (Name of Property Owner)
property located at 3 G ZI R: r r 16,1� U, S W 5 i s N G
(Address, Lqt, Block, Ro d, .)
on 1�itYCO S�" l 1�1 a- cr -Way , in S� 0 1'4 c-k- Coy N.C.
(Waterbody) Ci /Town andlor 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)
<-
WAIVER SECTION
I 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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Print oeType Name
'if 2. i "-, ass Mai. ing Address
1ol"r ti'G
City/04V
Oldtalzip
�3574
Telephone Number
Date
Signature r
Trkst
Print or Type Marne
SL 2 3 % fi rer- d r ctA2 S►,/
Meiling Address
S'AA J-�-
City/3�
Telephone Number
Date
(Revised 6/f V2012)
https://outlook.office365.com/mail/inbox/id/AAQkADVjMzg3NTMyLTIIMTMtNGM5Yy1 hNzQ4LThiOWM2NWZhNjc5YwAQAMZ5izllx1 Fx1 r9lwBZNWOQ... 1/2

NI -
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvada, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: -� - I S -) 0
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
A . 6 +l. -- L/L �K /V)f�.�>UE See det&-'s
Owner's Mailing Address:
4 1 z BLUcirdss (-+
A„i., ier
Phone Number (`i I(l ) -) 0,7 - o 3 5; i
Agent's Mailing Address:
p o. 6c))I- /o z
Phone NumberR,[O) / -SV3,�'
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at yt r V e L ip S �,f .po i,,, �, L - `t lv L-
This certification is valid thru (date) c�2" /-S-- a
;X . 4V
P party Owner signature Date
127 Cardinal Drive Ext, W*nk =, NC 28405
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
No Carolina
)Mora!!
An EWA Qpv t AfAn v1w Action Employer

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jac 4 's
1, (Name of Property Owner)
property located at Z i zv V e' n 51� s
(Address, Lot, Block, , etc.)
on hfC��Sfa 1 W�k� �� in r�ki1s�%'c4L , 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 DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I 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/ I do wish to waive the 16' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informal;'on)
�I
Jgnat re C I
Print 8r Type Name
2 rk4e-grass Ct
M iling Address
City ate/Zip
V1"-J1- 007-03Sq
Telephone Number
1)-/S-Jd
Date
(Ad-acent Property Owner Information)
Si ature
Pri t or Type 'Name
Mailing Address
City/State/Zip
SC.c / - n - (' �? -,5� 46 Z
Te one Nurhber
Date
-/S-Z
O
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN'r
i hereby certify that I own property adjacent to — ' ,i
�; (Name of Property Owner)
property located at 3 G 2 I've. L6. s'v�i
(Address, Lot, Block, Road, etc.)
on in _Sc j - (F111 N.C.
(Waterbody) (City/Town and/or County)`
The applicant has described to me. as shown below, the development proposed at the above location.
//
` -7 ! have no objection to this proposal.
! have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development nTust till in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, iiit, or groin must be set back a
minimum distance of 15' from my area of riparian access unless V12ived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
I do wish to waive the ; 5' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner In
Print o ype Name
Mailing Addre s
/<< i\c
1
Cifyytate2ip
`11"1- 00-1-
Telephone Number
�-is-2l+
Pate
(Adjacent Property Owner Information)
Signa evn K •mot 7.� lf�� er.141
Print or T Pe Namrr)
/at r�
MaililLc,address
or e�e� S_ Z ff�G
Cily'/state/Z!
Telephone Number! y
Date ---
(.Revised 6,1180012)

Data R-.tv d
Data D.PGMW
Ch-k From Nama
Nmmo of Permit Holder
Vendor
Ckack N—bor
ch. k
amount
Parrott N—b-/Co--M
t or Ra7und57wuocatod
Col —I
Cdumn2
CWumn3
Colu-4
Column5
CONmnD
C.1-7
CokrmnD
C.1-9
3/23/2020
W23/2020
B & K Marine Costruction
Permit Pals
Jacqueline Smith
Evelyn n rs
BUT
CresCom Bank
1370
3035
$ 200.00
S 200.00
GP #761890
GP #761270
88 rct. 10921
88 rct. 10922