57350D - Smith

'CAMA / ❑ DREDGE & FILL
3hEN ERAL PERMIT Previous permit #
1New :]Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized 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 / n�/
G� l/
A U�RGles attached.
t Name jW ._S;n, /4 � � V e - �/�, '1® Project Location: County 3Of o S �,i i4C 4-1
Street Address/ State Road/ Lot #(s) A2 % Swot c
State ' Yc ZIPS Y,1J
Fax # () Subdivision
:ed Agent G IW19Z ,1 464?a, r CiZIP 2 81A
❑ CW ❑ EW PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑ FC:
Phone # ( ) River Basin Lu-re
Adj. Wtr. Body 69 N o L dQ / Lv /✓ (nat
yes / no PNA yes / no Crit.Hab. yes / no Closest Mai. Wtr. Body /�
f Project/ Activity /C Q t�:"C is/
.,
(Scale:
ck)length
ngth
tuber
d/ Riprap length_
distance offshore_
u( distance offshore
cannel
)ic yards
rip
se/ Boatlift
ulldozing
Pow -
Length
not sure yes n "
not sure yes No
cum: n/a yes no
yes no
\ttached: yes no
ig permit maybe required by: ❑ See note on back regarding River Basin n

� � � �
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I . aril �� 11

9-Ij-tUIIkrKI) UU:C3 K11Ln rnLC VCI\CCR
MAY-09-2011 12:49 From: To:3368834366 P.2/2
ADJACENT RIPARIAN PROPERTY OVV 1 R STATUMNT
(FORA .PIEBM0ORNG P, ILMOS/BOilTUMBOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at _
(Lot, A1od4 Road, etc.)
on _ _ • M . N.C.
(Watcrbody) (Town And/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
ao objectioas to his proposal. I understand that a pier/mooting pilings/ boatlift / boathouse must be set
back a minimum distmce 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
I do wish to waive that setbuk requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSU DI WE
(To beJlled in by individual proposing development)
t5 �
dl-re,'e�s►Z�r1.S
dot-k / S4 m e
If you have objections to what is being propused, you must notlf`y tha Division orCoastal Management (DCM) In writin
within to deya of receipt afxhtf notice. Correspondence should bo mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can elan be contacted at [phone].
ffj ut 'onse ki en Ida n e na n A e !io it YOU hpve hMqjQflNd by Cert' ed Mail
(infor=Gon ror Proparty Owner/Applicant
Applying for parotit)
Wiling Address
Cd/, ,,Z �a� 3�
City/5ratolzip
(itiperian Property Owner Information)
Signaturo
Print or Type Name
r-7 /:n/1 , I

1-20-2011(FRI) 07:07 RITCH FRCE VENEER (FRX)3368834366 P.002/0
05/19/2011 02:16
19107545423
JMPARKER
PAGE 01/F
S. f E 3'l W • .
ADJACENT RIPARIAN PROPYRTY OWNER ST&TFMYNT
(FORA PIDWOORMI P�fLINGS1BOA7-U'VpBOAT770VSE)
I hereby certify that I own property adja=t to
(Natnc of Z roperty Owncr)
Pr opery located at
(Lot, Block, Road, etc.) /(
irl P!'r-.
on _ n (Tmm and/or County})
(Waterbody)
Applicant's phone #; 1�Utitng Address:
He has described to mr., as shown below, the development bO is proposing at that
�� ltboathnd,
have no objections to his proposal! I undmtand that a piamooring pd
must be set back a mirdmu h &5=c othe f tcell f k, YoQ�lmu fromimh$1 the approMY Orel ortipartpriatc blanket
waived by roc. (Ytyou wcs e
belvw•)
I do nit wish to waive
— 1 do wirGh to vOdvc that satba,clt requirement. � _—.__..._..---••-----•-----
... DESCRXY''F1:ON.ANIDIOSi U�,tA.WII+iG OF PROPOSED DEV�LOPA�J��V'i+:
(To be ffl# in by indivldscal proposingct�Iop►rtent)Jlv" 41, rll
FIECEivl
C)C,M WILMINGT
MAY 2 0 21
(Enfozmation, for Property owner Applying..__..__.-__..---•w--..__�...--..• _._ � _ ---- ---
for Permit)
Mailing Address
I/ - . J, 1 y77
(Riparian Pr pert- er'In oi-mutton}
j/ Pr Pert-
. =fl
Sisnature

pplicant: 6 1 , S12j1 -1 �
ate: '
�1111
Permit #: S 1`3S G3
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurem
)und in your Habitat code sheet.
abitat Name
DISTURB TYPE
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 Feel
(Anticipated I
disturbance.
Excludes and
restoration ai
temp impact
amount)
O G✓
Dredge ❑ Fill ❑ Both ❑ Other
12 r-
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 ❑

Pay to the
Order of
/ 66-IO S30 NC
—� 8NN1
Date
BankofAmerica.%
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