69263D - Smith

A B
*AMA / ❑ DREDGE & FILL
Previous permit #
MNERAL PERMIT
�lew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources Z
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0'714' 1 0()Rules attached.
r
Name r-v%'.
State ZIP Zb
( D`i) S2 - V (,y E-Mail
ed Agent A (be -f ma` a' ne
❑ CW AW ❑ PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes no PNA
Project Location: County � i •^ &, .6r
Street Address/ State Road/ Lot #(s)
Subdivision
City ©A= TSG(VN� ZIP 7-Rq(-
Phone # ( ) ' River Basin
Adj. Wtr. Body 4ot,x io��� (nat�1/i
Closest Maj. Wtr. Body_ �J
F Project/ Activity
(Scale: �
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tuber ■�
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Bulldozing■■■■■■■■■ ■■■■t■■■■■■■ Ott ■!■■11■►;
llrii■■■�■■■■■■■■■\J■ ��■ ;ice ■
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not sure yes Cho)
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s: yes
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d/ Riprap length
distance offshore
ier(s
ngth
g
ax distance offshore
nel
ubic yar s
imp
Boatlift
>use/
line Length
Wing permit may be required by: "-(p .1(� o +
❑ See note on back regarding River Basir

tx,*A
1, n
Of C1 f

1
hMu UttivtK
RTY 0WNER STATEMENT
.ADJACENT �tiPAR
iAN PROPE
adjacent to Name f Property Owner)
1 hereby certify that 1 ow�i Property
Qmperty located at _Lots Block, Road, etc.) /
a�
onE1---�----'"`--�^----�-� in (Town and/or County)
{Waterbody) J 016P N
Mailing Address:
Applicant's phone #:
OLJ - �3a G
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. ---------------
- - -- --
--------------------------------------- ---
DESCRIPTION AND/OR DRAWING OF PROP. jc Dvelpn e»t) PMEN -
(TO he filler! In by property owner proposing
�
cry �
f Cho*
I '
�/IUtI'�SQri .� T
- _4,C, _ )
u ------------r-
-"............
--------------
---
---------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Qwner Information)
Signature

NU UtLl VtK
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to :�,r�Z 's
(NAne of Property Owner)
property located at % 1$ s,A) f � �- .5�
(Lot, Block, Road, etc.) /
ona�s �___ --_ > in _�5 ��rJ , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: --ZY4 - a3a 70 )(D Mailing Address:_, ►^
Ak� QW 75
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
r%,I( b�z-o
16
ti ',
+
i
err ____
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -
Mailing Address:
S
Phone Number: Lol_�"
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
an� did
necessary for the following proposed development:
.e 01 &
at my property located at
in t a oirjk County.
_II1 furthermore certify that I am authorized to grant, and do in fact grant permissior
Division of Coastal Management staff, the Local Permit Officer and their agents to el
on the aforementioned lands in connection with evaluating information related to
permit application.
Property Owner Information:
Signature
Print or Type Name

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant: Ty )Y"� �p� 7—
Date: qm I ( 2
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FIP
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disl
Habitat Name
Choose One
includes any
Excludes any
total includes
Exc
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
tern
temp impacts)
impact amount
temp impacts)
am
L KA
Dredge ❑ Fill ❑ Both ❑ Other
21 (P
Dredge ❑ Fill [IBoth [IOther 14
30
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ 01her ❑

7/212017
Allied Marine Contractors
Allied Marine Contractors _
Allied Marine Contractors _:nf
Allied Marine Contractors
Chris Cichan
First Citizens Bank
5766
$200.00'GP 69262D
$200.00 GP 69321 D
$200.00 GP 69263D
7212017
Southern Premier Properties
First Citizens Bank
5768
7212017
Smith
First Citizens Bank
5765
7212017
Charles and Cammie Morris
First Citizens Bank
5767
$200.00 GP 69320D
7212007
Ethel A. Nobles
Alvin Nobles
South State Bank
6142
$200.00
GP 69340D
7212017
Will Richardson Construction
George McManus
BB&T
6774
$600.00
GP 69333D