77995A_Smith, Timothy & Coleen_20210129

i4CAMA I DA11009 & FILL B C D
GENERAL PERMIT
,/New modification Complete Reissue Partial Reissue Date previous permit issued _�
AS authorized by the Stem of North Carohns, DoPartment of Environmental QUA14
and tho Coastal Resources Commislow In In Area Of OWrOmnit"tal cOncOt!) POrmla"t w I SA NCAC_.1JL_LJQQ—*TM
ApplicaritName * Weer,- iti f- 4 l,-- Project 4Ocatiom cour" cot 1-4 �,L
Address 10;). St,91 I! INVC Street Address/ State Road/ Lot
City
Phone # (?5 Cf15f1% E-Mail 'ttli'A"
Subdivision
Authorized Agent no r I see— 'r ktj City zip
Affected Cw AW VPTA is "S Phone River Basin 4*10 101.
OEA lunikill
AEC(s): PWS HHF IH UM N/A Adf� Y*r. Body �t, (i—!>TW
ri—"t mti mitr. lk6dw A I tL, -%aw I kL,
ORW: yes <,7;�,h FNA yes 1 e;.
Type of Project/ Activity
(Sciala;
Plot ideicit) lefigth
Fw.w pwforno)
Floviin4ftlotm(s)
G"O'"Ier4o
number 4�,
rjulkhoa& Ri"
xiii dwv,o *Nha-o
max distance Ofthwo I t
But., &AA110" L-T 11
wbic yards
Boat ramp
segKI, sula"
OCIM
Sh"in a L#W ck
so not UWO )'" 60
tahiverAttatned`Y"
i Soo note on back regarding River Basm
A building permit may be required by;
(Note Local Planning Jurisdiction)
Notaxe Spatial Condiclons, li"'I"
enter'*,,. %�C— i- (:�,Z �Dbv, + , �e L4-
Ag&ra KMW Noma No
)<
signawro "Plo"Orwcom hance statement on back of permit Signature
Application Faiiis) ChKk # =UuOtg 0XV E.Pirit.0e..
7719

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Name of Property Owner Requesting Permit: I i i-A
Mailing Address: I U 1- 'S ha,'. C D
'S_ A-izU : 5 1,,, �4 (� C � '7
— J
Phone Number: 3 12 - 6)
Email Address: ­F 5 ryx
I certify that I have authorized
Agent f Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development 0r­A-f il�+
A
at my property located at I i ) '" L) bj'! C
in ( L, i F 14 v- c t(:- County.
/ furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
5- 1 ;Z
Date
This certification is valid through � I .� I

KA ati Z4!16011111111111 040 R4 3V -1q-412 6 0
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name of Prop" Owner:
Address of Prop":
(Lot of strw 0, Street or 1 (toad, W& county)
Agent's ;Jame #: C. rA M,Aiutn-
A00miss:
Agent's phone * /\JAt
I hereby certify that I own property adjacent to the above referenced property, The Individual
applying for this permit has described to me so shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must b& provided with this letter.
I have no objections to this proposal.' _ I have objections to this proposal,
If you have objections to what is teeing proposed, you must notify the Dholsion of Co"t*l Management
IDCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at 4=11wyZ "n orbycallingl-8884RCCAS7,
No response Is considered the some as no objection if you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings boat ramp, breakwater, boathouse, of lift Must
be sort back a minimum distance of 16'from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do twit wish to waive the 15' setback requirement.
1prooerity Owns
1--- —3 , K,
--I Ir--i
Signw—ure (/
Print or rype Name
'C' I?
mallf"ress
City/stakil/z/0
-7 S-7
Telephone N0Mb4r1`Fmat! Address
Oafq
(Rclan Prop" P)iwnt4 1pformation)
Signature 0
SHAWN J. SULLIVAN
Print or rype GM-0
P.O. BOX 242
Maft Address
Nc 27966
LAD123@A0L,QkM
rel9j,7horiii rVurff66-rrEm$il Address
(Revised Aug. 2014)

U6121:r
Emanuelson & Dad, Inc.
PO Box 448
Nags Head, NC 27969
Phone: [phone]
Fax: [phone]
Email emanuelson6705(a"ioutiook.com
01106/2021
Shawn Sullivan.
PO Box 242,
Powells Point. NC 27966
1111AIL"'
RECEIPT
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01/06/2021
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Re: Tim Smith - 102 Shore Drive. Jarvisburg, NC 27947
We have been requested by the above property owner to do the following work:
1 Install 1-10K Boadift and 4-10" x 30' poles.
2. Install hip roof over the boatlift.
In order for us to obtain the Cama permit for this project, Cama (Coastal Area Management) requires
each adjacent property owner to be notified. We would ask that you sign the attached form and return to
us as soon as you can. You may scan and email, fax or simply mail. We are also attaching a sketch of the
proposed project. If you have any questions, please do not hesitate to contact us. If you do have any
objections to the proposed work, you may contact Cama at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely,
Jackie Lewis -- —`
Emanuelson & Dad Inc.
■ Gonpiete items 1. 2, and 3.
■ print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the malVeM
or on the font it space permits.
Y; RrtAddressadto:
o�cl'�pp �
9590 9402 6133 02091051 45
2.
7018 1130 0001 7767 1909
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1? Agent
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enter de6ery address f7 No
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: ii (--" � t
Address of Property: J ko(-z L% 2,% 1 L-7
(Lot or Street tt, Street or Road; City & County)
Agent's Names. 4J MailingAd a$s: t _
Agent's phoneme i� I. t� �:7 ! ' = _ _"_Ge. c✓' f 1 �
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing.the development
they are proposing. A gM1iptt[on or drawinOWdh 0IM(lrisions, mLl4t be ➢toyio Aftit IS �tiPt
l ha4c no objections to this proposal. � I have objections ki this proposal.
If you have objections to what is being proposed, you must noW the Division of Coastal Management
(OCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices +s
available at , or by calling 1-888-4RCOA3 T
No response is considered the same as no obitiction if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp breakwater, boathouse, or lift must
be set back a minimum distance of 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 wish to waive the IS' setback requirement,
I do not wish to waive the 15' setback requirement.
(Property Owner information)
Sfgnrttu�
Prptt or Type )Vamp
2-
Mad ttg Address
Q%4,ty i86uv�.nJC?%��f�
Teleotx�tr Nun �� .._
(Riparian Property Owner Information;
,Sf�nurruc�
Ptvd or Type Native
Madlinq Addmvv
Oty/sfalolzjp
Telephon® urrt Finatl Addf
(f?evised Aug 2014)

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a
Emanue[son & Dad, Inc.
PO sox 448
Nags Mead, NC 27959
Phone: [phone]
Fax: [phone]
Email: emanuelson6705Ca�outiook com o
m
01/0612021
a
0
r
David and Kim Owens
100 Shore Drive,
Jarvisburg. NC 27947
Re Tim Smith — 102 Shore Drive. Jarvisburg, NC 27947
We have been requested by the above property owner to do the following work:
1 Install 1-10K Boatif t and 4-10" x 30 poles
2. Install hip roof over the boatlift.
In order for us to obtain the Cama permit for this project, Cama (Coastal Area Management) requires
each adjacent property owner to be notified. We would ask that you sign the attached form and return to
us as soon as you can. You may scan and email, fax or simply mail. We are also attaching a sketch of the
proposed project. If you have any questions, please do not hesitate to contact us. If you do have any
objections to the proposed work, you may contact Carina at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely,
8 Complete Items 1, 2. and 3.
A. 8iprM&m
8 Print your name and address on the reverse
Jackie Lewis
ilt� c -� �'� O Agent
so that we can return the card to you.
Emanuelson 8 Dad Inc ■ attach this card to the back of the mailplece,
0 Aduessae
B. Reow-dby0'++%WNarrW E Data ofbovery
or on the front tf space permits.
ravi.0-r Kt Ott O.t 4,vt-S
".ary address ir. smm ? L7
H YES, enter delivery
address balow,
0t S�-ote
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3 C;ol3w:t cn D�vca'y Rrstr+eted Oaaesy ❑ 5i�raptrgCsx..
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CONSTRUCTION
ENGINEERING
SERVICES, INC.
P.O. Box 665, Mateo, NC 27954
[phone]
FAX [phone]
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shown on this map.

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