40406D - Smith

,,CAMA./'�'bREDGE & FILL ;, 4
NERAL PERMIT Previous permit#
New _Modification -Complete Reissue —Partial Reissu Date previous permit issued
eized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 71/,/f D 0
EiXiles attached.
t Name AI WA eV eeA c t1 Project Location: County 8k 1404,'(- .
5 5`71 WAIttc l nn�,,• ____ Street Address/State Road/Lot#(s) 177 (o aeA
44 A. TcI-P ?..0.,4-c1.I _State A- (' ZIP ? 6 y ES/��iTrto S
( J) 57y 9/14 Fax#( ) Subdivision c,24 4 re CQ S
ed Agent &/QE.-C, 6{//o/pe/✓// City a,/ Scitply ZIP .JV (C
--Cw N PTA VES Ii PTS Phone# ( ) River Basin L Kwv4
OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (if i #L Oi/• IftWk+/ (nat ei
❑ PWS: li FC:
✓�/�` Closest Maj.Wtr. Body Ar+ 11
yes C0 PNA yes /6:3 Crit.Hab. yes / no
Project/Activity 23,,//( ,F/) 3Z12 p/4 pme,�.t' (' /6.� �)
(Scale:/ = 5
ck)length
i(s)
ier(s)
ngth 5 cA A P-4-
'1C44—/0G r\.. wetclr
prap length /&$ _ N N
distance offshore
F- / se' 'i
x distance offshore 5
cannel l ___ . _ . .
)ic yards ri
ip ,�J,/� >ri SFiuG-
se/Boatlift ea.A 1$IJ Q.4}
ulldozing
itZ
a LengthA-21,0
not sure yes (�1 )
s: not sure yes 1n91
cum: n/a yes tc)
yes 9
\ttached: yes no
ng permit may be required by: /3404,514 C/C to • See note on back regarding River Basin ri

J4/9b/28Ii5 11:2b '31b2B/451iF7 WAY1 5 tSAC�CHUt 5tK F'A(at
•
DJ\')iON OF C',r_,A ,T.SL MANAGEMENT
AU.1.4CENT 1_11'AT;_iAN PROPERTY ()\VNEF: N(.►TF)CATlC ) /w&1V-F: FORM
!arm of Individual App)\'ir,g For Permit. 0404� �i Sim f
s
.ddress of Property:
. (Lot or Street#l, Street or. Road)
(City and County) _
hereby certify that I own property adjacent to the above-referenced-.properry. The individual
plying for this permit has described to me as shown on the attached drawing the development they
e proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
ix
you have objections to what is being proposed, please write the Division of Coastal
:anagetnent, 127 Cardinal Drive Extension, Wilmington, NC 2g405 or call 910-395-3900
ithiu 10 days of receipt of this notice. No response is considered the same as no objection if
la have been notified by Certified Mail. Ca y''Q\ f I \4. S- bC
1\1 WANNER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
t bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
,u Wish to waive the setback,you must initial the appropriate blank below.)
1V ik I do wish to waive the 15' setback requirement.
t% I do not wish to waive the 15' setback requirement.
11\lame7161-441
Date
5 01/4) , A,,,,,r

G.1L.tMt_mot t ►clr wctN►iw vi<UrL•K LY UwNt NOTIFIC6 LQN/WAtyTR FURM
Name of individual Applying For Permit: '! �i`. . •
- -r
Address of Property__ -��`` 1 _
•
(Lot or Street#,Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The individual
applying for this permit has described tome as shown on de attached drawing the development they
are oroposinz. A description or drawing, with dimcrlsiots, should be provided with this letter
i it. I have no objections to this proposal.
ro osal.
If you have objections to what is being proposed, please write the Division of Coastal
Management., 127 Cardinal Drive Extension, Wilmington, NC 2840$ or calf 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTI<TN
I understand that a pier,dock,mooring pilings, breakwater,boat house or boat hit must be
set bck a minimum distance of 15' from my area of riparian access-unless waived by tue. (If
you wish to waive the setback,you must initial the appropriate blank below.)
t do wish to waive the 15'sctbatk requirement.
I do not wish to waive the 15'setback requirement.
MEIRMIIIMM
Sign Name Date
Sa.rw s AitA
Print Name
0J �r
_ : p Gi p �,�
NCDENR
�. wo ,O[ rM</
elcr h0nr N►lT ham. with �.-e /��J_ .e..u..�.,,wawe.lMabN�tu 1

M Vtfl AeA/Z)
VV
WACCAMAW •
BANK •
, ,� w
Su ppl.%NC 28462 Sloclok, T'' I f I
wurwavauamarubank. �(�
For5 � v4" FPpI�M1�/
1:0531L2LS21:8000L5753000190
• OC'lark Amrrian WILDLIFE PORTRAITS.WDWP
•
•
•
•