63171D - Smith

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CARIIA / PDREDGE & FILL Q�k '�Y` L y
RIV ERAL PERMIT "', Previous permit #
Vew [-]Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
I"- r+t
zed by the State of North Carolina, Department of Environment and Natural Resources --f /
Dastal Resources Commission in an area of environmental concern pursuant to I SA NCAC f� "� / - /
ules a ched.
Z^rfe.
t �P1141 J1 L State- ZIP
Fax # ( )
.d Agent e*7
❑ CW ❑ EW ❑ PTA yriS MOTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
�
yes / �ro PNA yes `."_
Project/ Activity
0*7-` /Jh/n
�a
:k) length
(s)
ier(s)
ngth
�nber
}
,;/_Riprap length /10
distance offshore a
uc distance offshore O
iannel
bic yards
r
np
ise/ Boatlift '—
ie Length >' S+�D
notsure yes n0
1t
;s: not sure yes 45p1
rium: n/a yes 05�.
y no
Attached: yes t10
/
ling permit may be required by: Cp r. ❑ See note on back regarding River Basin
yes / no
Project Location: County /�%Gv✓ /�io/
Street Address/ State
//Road/ Lot #(s)
Subdivision
City 1 I� ."' I► ZIP 'ZO
Phone # ( ) t River Basin
Adj. Wtr. Body at r
Closest Maj. Wtr. Body 17�r'�
(Scale: I % L)

pp)icant: S✓Vt i C� �' ��
ate: G�G, D ✓1
.F%2 ell/
Permit 31 ?
,scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name DISTURB TYPE
Choose One
TOTAL 5q. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance_
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
—:::�Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ElOther ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own
property located at
propertyadjacentto J4L ('
. L c f
(Name of Property Own )
on S �,�;-� l� (Address, Lot, Block, Road, etc.)
(Waterbody) in
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the abov
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 dt
—
DCM WILMINGTON, NC
MAR 2 0 2014,
I understand that a pier, dock, moorin WAIVER SECTION
minimum distance of 15' from my area Oflriparian ccessrunless waived , boathouse, ftby me �(if You i s
the setback, you must initial the appropriate blank below.) y ( you wish
... A* I do wish to waive the 15' setback requirement.
—A / / I do not wish to waive the 15' setback requirement.
/Drwww�a..
• ..M�Lr owner mrormation)
Signature
r 4P A tiX
Pr t or T pe Name
d of
(Adjacent Property Owner Information)
Signature,
Print or Type Na e

I hereby certify that I own property adjacent to
property located at �QS S ( ame of Pro a Ow er
(Add
on �� �� ress,
(Waterbody) in -
The applicant has described to me,
:k, Road, etc.)
� U4r0�
(City/Town and/or County)
N.0
as shown below, the development proposed at the above Ic
I have no objection to this proposal.
I have objections to this proposal.
""J'-0K't i 1UN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site draw,
s V'�"��
A c'
RECEIVED
DCM VALMO GTON, NC
MAR 2 4 2014,
I understand that a pier, dock, mooringWAIVER SECTION
minimum distance of 15' from my area offlriparian accessr, boat
unless waived by me in must be set b
the setback, you must initial the appropriate blank below.) y (If you wish to r
=l--_ I do wish to waive the 15' setback requirement. q rement.
—AL/1— I do not wish to waive the 15' setback requirement. q ement.
-�-.•'r %owwolal mrormation)
Signature
P, torT peName���x
- 0 aIfii
AAndi. A J�
(Adjacent Property Owner Information)
Signature
�"��T.� w•�/�Lti, i)%i1/GT� is
Pnnt�or Type ame
i1/�r�o 7

I hereby certify that I own property adjacent to
property located at oZ G ( me of property O er)
on �Q (Address, L t, Block, Ro , etc.)
(VUaterbody) , in A''
(Cl 1Town an /or County)
The applicant has described to me, as shown below, the development proposed at the a
boi
I have no objection to this proposal.
I have objections to this proposal.
ur-Ok KU'rION AND/OR PM
DRAMNG OF PROPOSED DEVELOENT
(Individual proposing development must fill in description below or attach a site d
'k*,Ck
w,
ReV\me
-cl4V4\' I
: �bb� ----
�� 1(►.AO� ►dN: AO�Tr M
MAR 2 0 2014,
IVER SECTION
I understand that a pier, dock, mooringM/A.
minimum distance of 15' from my area of r riparian ccessrunless wa veld iftby groin must s
the setback, you must initial the appropriate blank below.) me. (If you wish
A* I do wish to waive the 15' setback requirement. q rrement.
I do not wish to waive the 15' setback r
,r%
1 -parry vwner Information)
Signature
r a
Pr,t or T pe Name
- 0 �"'bk aIfi1
Wifinrr d,-!rlro
equrrement.
(Adjacent Property Owner Information)
S re
rnni or Type Name

P.O. Box 2151
Wilmington, NC 28402
3 910-279-3796
HARBOR NES-- [e-mail]
[e-mail]
A
(� PAY TO THE � yV
� ORDER OF ' �.'
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A TAMPER RESISTANT TONER AREA A
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BANK OF AMERICA, NA
66-019/530
65949
� $ .9 66%
DOLLARS
VOID AFTER 90 DAYS
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