68564D - Smith

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'ENERAL PERMIT Previous permit#
$4ew ❑Modification []Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources j
'oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Do
❑ Rules attached.
Name Project Location: County
Street Address/ State Road/ Lot #(s)
J� State A C ZIP Z (U� Gi v p 00 .
(33(,) 251 - ZyONE-Mail Subdivision i /
sd Agent (n; a �vOonS"c n,% City Y�Jo I J ? , ZIP / ,/,_
❑ CW ElEW El� PTA KES PTS Phone # ( ) River Basin w n,1
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
des / 60D
PNA yes ../ no'
Project/ Activity /Jv ( k
:k) length
tform(s)
'latform(s)
igth
nber
I%Riprap length__
distance offshore u
K distance offshore d
annel 1
,ic yards
ip
se/ Boatl
dldozing !
I
;ry
LO
Length
not sure yes
3
um: n/a yes
[ no
yes
no
ktached: yes
no
ig permit may be required by:
Adj. vvtr. Body , i^ ct (nat
i
Closest Maj. Wtr. Body. - /f 1 IJ4.
(Scale: I r� 7
❑ See note on back regarding River Basin n

ArCEVER
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: /t? ` /10A-7
lame of Property Owner Applying for Permit: Name of Authorized -Agent for this project:
Wner's Mailing Address: Agent's Mailing A dre s:
L-7
� � r Q, Z'
'hone Number C ?�Ll a 7 - a l o Phone Number -Y - �q
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r arid-Qbtaining all CAMA Permits necessary to install -or cq ptryct the follolqing (activity):
or my property located at
'his certification is valid thru (date) l E'- ) r-�
P _arty Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: u1` YJ V �0CCl t ►
Address of Property:
(Lot 4 Street #,
Agent's Name #: GE
Agent's phone #�� 5�9 9e95
or Road, City &
Mailing Address:U I � BoQL+ \ ►✓c-
���1� �czuc�r1 I�IC Z�s'1(�G
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this hermit has described to me as shown on the attached drawin the development they are proposing.
M Alum
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 Divi ' n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correse should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent oan also be
contacted at [phone]. No response is considered the same as no objection 010"" been
notified by Certified Mail.
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 byme. (if you wish to waive the
setback, you must initial the appropriate blank below.)
J _1-do—wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
"�A� �A cs�
Si nature -- - - -
r
Pr' e Name
� ) UA 6c-d C, cc
ailing Address
City te/Zip
(Adjacent Property Owner Information)
- ignature
-L S,rf::� W '.kl�-�,rNt
Print or Type Name
Mailing Address
TriY\ I-y C- 2'0? j.
City&tate/Zip

CERTIFIED MAIL, o RETURN RECEIPT REQUESTED
DIVISION O COASTAL MANAGEMENT
ADJACENT RIPARIAN PROP66TY"OWNER NOTIFICATIONJWAIVER FORM
Name of Property Owner: � 50, r' 1
Address of Property: \, \
(Lot o Street
Agent's Name#:acict &�&aC.,�1��1
Agent's phone #: R' SSG -Qb9
or Road, City & County)
Mailing Address:COIU I 6QQ6A Dc— '
i�, sle ?y-c n NC 2<6%9
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.
X,descttetid? -f-d-d irf NO itlS10 N64 fruit661MI f6'W44t oti�°:Ib'�ie�.
1 have no objections to this proposal. 1 have objections to this proposal. _-
If you have objections to what- is being proposed, you must notify the Divis't?n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Corresp�ce should ba
mailed to 127 Cardinal. Drive Ext., Wilmington, NC, 2840$-3845. DCM representd60S can also be
contacted at [phone]. No response is considered the some as. no objection ifjiK4ht�vi� been
notified by Certified Mail.
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.) .
, F l-do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
"��
Si nature
Pr' e Name
1�cc�- W6---rd C�
ailing Address
(Adjacent Property Owner Information)
--Signature
Print or Type Name
iv9 IAL ,
r.
Mailing Addre s

i
v
i

ite hs 1, 4aM.0. s '
name and address on thOroverse.
can return the card to you.
s card to the back of the mailpiecd*7
front if space permits.
ressed to:
;� Shaer
A. Sigrkature
X
B. Received by
D. Is delivery address dii
If YES, enter delivery
/ ,,❑�, Agent
l� Addressee
C. Date of Delivery
II I
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3. Service Type
❑ Priority Mail Express(D
III
III
I II I
I II
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❑ Adult Signature
❑ Registered MailTI
Adult Signature Restricted Delivery
❑ Registered Mail Restricted
9402 2219 6193 1026 59
Certified MZO
Delivery
Certified Mail Restricted Delivery
�1 Return Receipt for
❑ Collect on Delivery
/ Merchandise
❑Collect on Delivery Restricted Delivery
Signature Confirmation T^'
0660 0000 7486 5098
Mail
Mail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
. ---1 --kvv— Woo)
1, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
as & t-ees (cbeox bar, aao �ppppAlrey
celpt (hardcopy) $ i� ��
ceipt (electronic) $
Aail Restricted Delivery $
iature Required $ _
tature Restricted Delivery $
:I.4.9 i a
iplete items 1, 2, and 3.
t your name and address on the reverse
hat we can return the card to you.
.ch this card to the back of the mailpiece,
n the front if space permits.
,le Addressed to:
1 t
A. Sign ure
X
B. Receiv y (Printed Name) Cr P to
D. Is delivery address different from item ibll- Ye`•
to VCQ —+— riol;-- —lrir— h.1— M Nn
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