61647D - Smith

CAMA / DREDGE & FILL
E N E RAL PERMIT AkC Previous permit #
New Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 0
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
/. ❑ Rules attached.
t Name' % �/! Project Location: County'
s_ T _ f Street Address/ State Road/ Lot #(s)
r � �
State ZIP
rax # ( ) Subdivision
zed Agent -=� ' ' -_'.. _ =r ✓� �'j City ,i / ✓ ZIP.
cw Ew PTA ES -1PTS Phone # ( ) River Basin
OEA HHF IH E, UBA N/A / / rJ! / '
PWS Ft:
yes / no PNA yes / no
)f Project/ Activity _
otk) length
m(s)
ength
umber
;;'fZprap length
vg distance offshore4,
iax distance offshore
-hannel
ubic yards
imp
Ouse/ Boatlift
Bulldozing
ne Length
Adj. vvtr. BodLat
Closest Maj. Wtr. Body
Crit.Hab. yes / no)
'
not sure
yes
no
I
gs: not sure
yes
no '
)num: n/a
yes
no
yes
no
Attached:
yes
no '-
(Scale: / / /
ling permit may be required by: - ``�]gp k r in

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1X El
El
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,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to �xf 5�,64
(Name lof Property Owner)
property located at V [ (n 5 9
(Lot, Block, Road, etc.)
on (� � - { � C11, N.C.
(Waterbody) (Town and/or Co ty)
Applicant's phone #: 9lb 5qt q0% Mailing Address:
(° C 3
He has described to me, as shown below, the development he is proposing at at 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 (1T) 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
(Riparian Property Owner Informat' n)
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Tev'e'c, J-2 • 's
' t 1 (Name of Property Owner)
property located at S �) w -k 5 m ,J
(Lot, Block, Road, etc.)
on C►�� , in N.C.
(Waterbody) (Town a d/or County)
Applicant's phone #:
Mailing Address: to
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 (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 not wish to waive
r 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)
0 Q ok 0
Mailing Address
(Riparian Property Owner Information)
Signature 1

ALT7i-I�y
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date �Z—/.7 '/j
Name of Property Owner Applying fpr Permit:
Mailing Address:
A), `j4zW
�Yi�
I certify that I have authorized (agent) 1.t Ci �`E p fl,� ? ,t -e to act on my
behalf, for the purpose of applying for and obtaining all CA.L=k Permits necessary to
install or construct (activity
at (my property located at)
This certification is valid thru (date)
Pronertv Owner Signature
Pate

J � ' Permit #:(Of to
y
be below the HABITAT disturbances for'the application. All values should match the name, and units of measurement
in your Habitat code sheet.
DISTURB TYPE
t Name Choose One
TOTAL Sq. 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
disturbaAce-
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fil Both 0 Other ❑
3
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 ❑

IGHTHOUSE MARINE CONSTRUCTION INC 4586
PO BOX 2532
SURF CITY NC 28445-0028 66-19/530 NC
p 58754
DATE r (-
Allc- 0 i'l) $
v F:
DOLLARS 8 a:.t"•^^
AAmerica
00196