54443D - Smith

CAMA / ', DREDGE & FILL 54
3ENERAL PERMIT Previous permit #
]New El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 1 I /.
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC I VV�
1 Rules attached.
it Nam'' ie t 1 { f ++ J Project Location: County �' i 1'
t �i l � l o-' f - k-C (A(( Street Address/ State Road/ Lot #(s)
�Mp� i�� ►� Statezip o C�� x7��t L�,16 1is Kwid
t io) - (; Fax # ( ) Subdivision �IA
:edAgent i) k[City `-{any, zip C&wJ
❑ CW 'NEW d,PTA XES ❑ PTS Phone # ( ) '�P' wd River Basin Q ¢
❑ OEA ❑ HHF ❑ IH ❑ UBA D N/A
Adj. Wtr. Body '�\ Y `' �F aVf ,U4 at i
❑ PWS: ❑ FC:
/1, oue 1. ), ,._;�,,.�. ,� Closest Maj. Wtr. Body
f Project/ Activity
angth
amber
id/ Riprap length �)C)
g distance offshore
ax distance offshore__
hannel
ioic yaras
,np
ise/ Boatl
P I LE�2 A D 1 Zb
ie Length VIF 1-1 5
not sure yes no
L
;s• not sure yes no
I
rium: n/a yes no '
yes no
Attached: yes no
ing permit may be required by:
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❑ See note on back regarding River Basin r

eb 26 10 01:25p Duke Ladd 910-251-3690 p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ 2c, a-s 2-n/c is
(Name of Property Owner)
property located at 2CL In 1 L L ,gc 2 - � a
(Lot, Block, Road, etc.)
on '�nr r �a � ��Zc , in lJ,--I, i o'�crrZ C`�h N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address:
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 individual proposing development)
(Information for Property Owner/Applicant (Riparian Property Owner Information)
Applying for permit)
Mailing Address Signature
W t L m 1 lv (,-T (-,x1 kiL Z N 0 q M• ))tA kl� L,9-17 f)
City/State/Zip Print or Type Name
Telephone Number Telephone Number
nzlz41
Signature Date Date
127 Cardinal Drive Ext, Wilmington, North Carolina 28405-3945
Phone: [phone] FAX: [phone] Internet www.nc coastalmanagementnet
An Equal Opportunity \ Affirmative Action Employer-50% Recycled \ 10% Post Consurner Paper

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE) f
I hereby certify that I own property adjacent to 1. S b�
(Name of Property Owner) �J
property located at
(Lot, Block, Road, etc.)
on /� ,L w , in Ngl (J�/z , N.C.
(Waterbody) (T-ow*-xnd/or County)
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 (1 S') 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)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to !� sn, i tl�l is
(Name of Property Owner)
property located at �J 4 P` I 1 I
(Lot, Block, Road, etc.)
on � VY , in Nr,01 b fOVYTIz , N.C.
(Waterbody) (T -own-a-ad/or County)
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 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)
------------ -------- ----- ---- -------------------
Signature

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DOUGLAS R HORNE 247
292 Willfiarns Rd 66-21/5
Cl �• � tt�@ y C 28409 � � 1` � i b BRANCH 7
Pay to the 0 & 11 i /z I Q 7 „v
Order ofy 1 rr�/ /� � n � l `�' LV (�
! U - ' t, �J L--n �' " ( ( (.1 � Douars
WACHOVIA Ca�53 �nht�
Wachovia Bank, N.A. O
For Awwachovia.com //yy���� l r, , , '4�
t�.� ��IJ6` K142C• L✓�,Iq
1:0S30002 L9i: i086 L3S3S430 L1 2470
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Vincent R. Smith NCDL 5877112 66-30/ 31 6,
Sharon V. Smith NCDL 1338196
284 Williams Rd 791-1760
Wilmington, NC 28409 Z
/ DATE
PAY TO THE /t/
ORDER OF
First Citizens
Bank
firslcitizens.com i�(�!�
FOR �C�
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1:0S3 L003001:003S3647 26
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3 111@ 06979

: Division of Coastal Mgt. Habitat impact Computer Sheet
licant: vd m'd k, 6V 0 Q " 6YKI Permit #
0
5�F�f-3 D
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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 Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill V Both ❑ Other ❑
O
O
�
Dredge ❑ Fill ❑ Both ❑ Other ❑
a32-
aV2
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 ❑
S�3 l 15 x = 230