61552D - Green

CAMA / ❑ DREDGE & FILL tA
iENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue 'Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
##Nam e -�-��' f Project Location: County.=:
IZ T 1 la Cft E b`t ✓rYf KI ICI L Street Address/ State Road/ Lot #(s)
Un h Statet`! ZIP 2 33 3 �T 61 V C P1 J r"� +
(910)a Fax # ( ) Subdivision NA
;d Agent _/ t(,(, t (-(r City (,U&W S G ( fG U. ZIP L�i "I�C�
G CW EW :1 PTA J ES PTS Phone # 1 ' j (> ) 1 I 'f5L 7 River Basin L01,14
❑ OEA ❑ HHF I - UBA N/A
Li PWS: ❑FC. Adj. Wtr. Body 00-hAl (nat ft
Closest Maj. Wtr. Body M WW
res / no PNA yes / no Crit.Hab. yes / no
Project/ Activity
.. (Scale:
k) length
:s) x Z�
ar(s)
igth
fiber
/ Riprap length
distance offshore
c distance offshore
annel
is yards
P
;e/ Boatlift
illdozing r
:A A'g If X l lc
Length
not sure yes (nD
not sure yes ono
um:
�� Yes no
attached: yes no
ig permit may be required by:
�❑ See note on back regarding River Basin n

I1V .1dPay-
4

WNE R—
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverl Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
r
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
4
Owner's Mailing Address: AgenL's Mallfng Address:
Phone Number (910) 9-9� ' Y `% et� Z Phore Number
I certify that I have authorized the agent listed above to act on r^y behalf. for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
—1)ek
For rry, property located at
CC c HvI —L i3Y.cu (M L
This certification is valid thru (date)�� 1
- roperty Ow r Signature Date
-� rY 1" l
I Une., — ,.

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATH"OUSE)
I hereby certify that I own property adjacent to n �J !E 6� e-�
(Name of Property Owner)
property located at 19 y
(Lot, Block, Road, etc.)
on C9 41✓ F C1 � � , N.C.
(Waterbody) (Town and/or County)
G
PP P / 0 3 �j'�' u4;g ,�i7
A licant's hone #: 9 1Vfailin Address: �� iC /CIJr/0G/`t� /T
n / .
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I T) 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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
(Riparian Property Owner Information)
�v
Signature
Print or Type Name
Telephone Number

f I``R .4 Pit R "M4ira:'r; l'Ir:1,vr, rF`ril�llx l M rt I
hstcF ►�rtc that ,,,., F• t} f
JM to ` + !"w�� r
p�fi►�crrti- t� tatCd aS .--�_�,. t_-- %? '�/_� �.,;'�. ! %�% � .,.
_r n n�...._
aftivor Zuunttlr)
�ppltrattt's pQnne �r: _
fliling Addrett
He has deschhed to mG, as shown below, the develvp nrnt he is pw-v Js$ at !hat k.catv►, In.
ttsrt tk1hjrtlar�s to h1s nnsat 1 ,.n�er.tar�cl t?�it n f+,er+mCKI Pilings r %stith 'tnac:,-• r
must he ;tt track a minim .m 1Fvan.e fitfee 1 f:e: kv r .ry aria ur,ittAn x"rf.;:
%hived by trtt. M you wi}b to -wialve rbe setback. `uu roust iaEti�l the sl+ ra)rreAtc bl�ttk
below -)
I do hot w15h t_, Pr'.
I do wish to wat.c `.: at k r:gl,,r.:-t't7t
_�_.--�pEti(`Rtf'Tl(?`# :�til�.f'1)� i}lt.s�4ltit� (?!' t'itUPtt�ED #1t;t•ELt?F�iF:Ni
�l h•' !It+'+'i !I! CrI.JJ ti:,131 ( �71rY�'i•Jlly,' ,,►�'iel!)�'T.[RJ)
-------�•• ,_•�-�.-�-••r^—...�bEf T17�41:11tiClt101
tR,Partao Prop i"._,?
{lnformadon for Property Uwace DP A i> S
('r Permit)
-T-

dW *D NI 11
I m

applicant: v C rWV � Permit #:
)ate:
3Ia�
lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
abitat Name DISTURB TYPE Disturbance total
Choose One 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
I
'
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 ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
xg' �Z

R SMITH SOLE PROP
SMITH BUILDERS
4D ST
BEACH NC 28469-7630
America
1345
66-19/530 NC
2304
77,