39807D - Smith

CAMA/ Fi DREDGE & FILL
CEhIERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissu Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Na ural Resources
a Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 71/. 2 100
Rules attached.
int Name ZI U-t A'l/) i77/'ni / Project Location: County 5)2 i Su/iGl<
;s .255-,E{ 4n(-vest 5 c.4.,4 Street Address/State Road/Lot#(s) L,0r ,2 G.
cDt/774pm.+ State /(/ ZIP ZSyd( ,25TSd /y142i Ale 2s Ll/A/y
#( q/o) 25 3 - miFax#( ) Subdivision 6 JAMGS P/-4417:477
•ized Agent CV-10E r4"54.,0tr H -•``oe//kf cc- City 5-0 U77/P�T ZIP _ L
een/nar Art L
d ❑CW EW C�'PTA E ES ❑PTS Phone# ( ) River Basin
❑OEA ❑HHF ❑IH C UBA ❑N/A
►: Adj.Wtr. Body si/Gf/tt/ (nat
❑ PWS: ❑FC:
14
yes /9 PNA yes /9 Crit.Hab. yes / no Closest Maj.Wtr. Body /4/Lt/
of Project/Activity ?RepOS&) l zo 52eAvet 444Te2 I//.i/y/ /0A4.i / 5
3-(' 4$0 ve Suh 51-0,-f - /"64/5 5'64ps 115 ,e2 CSC /iv185 (Scale: !N'
dock)length
rm(s) . — N j vV rA J '- "— ..+
•pier(s) / r v
length
number / ek'sT
/A,
ead/Riprap length / O O P&
avg distance offshore / Q
max distance offshore /
channel / 0 a�.1
cubic yards /
amp / PrOP 5e D /
ouse/Boatlih Z. Vile L SaeA(G( R G ,
•
i Bulldozing / r( p A
•$ram ru w-re2 ( I/ /aio' - '
/90/x 3-& f v`-ir. • z,-,
I rd s„ ..'L. N
:line Length POI
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not sure yes 6,
1� t !- 4, —41 5/4
lags: not sure yes //}Ol,f` 1 v/ V y , t j '
torium: n/a 1YVV _ ' ?)511
TL{ prop V
y ( + OR I M 14-rt-SN V sk i f .air �s r y P
,s: y no D 1-0T .2w Ai
:r Attached: a no Lp /Lr
(ding permit may be required by: gl2O,V51.,'tc`( GD __See note on back regarding River Basir
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• DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 65;4 r R I C_/7 f 4d2 4 Y v i
Address of Property: A. 65g? /v l v F,s 10/t Y s
(Lot or Street #, Street or Road) r
��ov a BR vrv,s-ki dry if(
(City and ounty)
I hereby certify that I own property adjacent to the above-referenced property. The individu
applying for this permit has described to me as shown on the attached drawing the development th(
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
Ef you have objections to what is being proposed, please write the Division of Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39(
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must t
;et bck a minimum distance of 15' from my area of riparian access- unless waived by me. (
Jou wish to waive the setback, you must initial the appropriate blank below.)
L I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
ft/(' // i
,ign I'me ate
7/2. 'l Dr Lam;ilkf/ c'771 A. A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: S ,.ir l JG'l
Address of Property: c2 S 5 ' l'l(/t it IA)6 A34 y SE
(Lot or Street#, Street or Road)
oz-d e-d ,8,eutisw6c.,,‹ cry' /vc6 4
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individu
applying for this permit has described to me as shown on the attached drawing the development thf
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39(
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must L
;et bck a minimum distance of 15' from my area of riparian access- unless waived by me.
7ou wish to waive the setback, you must initial the appropriate blank below.)
/
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
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lign Name Date
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CLYDE FARNSWORTH 910 253 4338 P. 09
in 08 05 05251p Becky Klass 910-846-3360 p•3
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CLYDE FARNSWORTH 910 253 4338 P. 02
n 08 05 05151p Becky Klass 910-846-3360 p. 2
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Pay l at 'ev'C,Yv-tt b $
to the order f.� / ,, 7
4�'�- Dollars 8
Bank of America
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ACH R/T 053000196
Memo C� 0t A F-.e-t.p l c
•:053000 L961: 000668 5 5 2 LL, clo 2600
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