33401D - Smith

0 CAMA / DREDGE & FILL APT'
33401 J)
GENERAL PERMIT Previous permit #
)C
__New ��lodification Complete Reissue Partial Reissue Date previous permit issued
.
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
Rules attached.
Applicant Name ri\ Fr r 5 n i t V1 Project Location: County 0!r U n 5(,t) a C_K--_
Address 59 3 2 A r\e k on b r; V Street Address/State Road/ Lot#(s) 3
City OA td3C State N ZIP c'71 0 C m ber-I -nrl 5-1--r. e f'
Phone#(')3(p) 4ul3`0B5(o Fax#( ) Subdivision
Authorized Agent \frr jM 1{ _ City 6ee.44-►l Ts IC ZIP 0?6 4(09
Affected C'CW lik EW litPTA ❑ES ._PTS Phone# ( ) River Basin /-1,401 b e-C
❑OEA ❑HHF ❑IH ❑UBA N/A
AEC(s): Adj.Wtr. Bodyt
ElPWS no : ❑FC:no 1 wt (nat unkn)
bii
ORW: yes PNA yes Crit. Hab. yes / no
Closest Maj.Wtr. Body
Type of Project/Activity .W [ frr1p R'T.C,i +oft+, rn d OCz.
(Scale: pal— Tv )
Pier(dock)length 14-16
r kr,P
r f I
Platform(s) k o10tCl T _ I — --t --- j - .
. i
Finger pier(s) i I ��--,/1 t 1 �I\ ^�j I I
t i I - . _ I j I i
Groin length I j iI
number — •
-
Bulkhead/Riprap length I I
I I i.
avg distance offshore I I I Ii
max distance offshore __;__ I 1 i I ,_-._.;___ -
i
Basin,channel I I I I
�. •
f....—.__. ! I — __._._j _ ..
cubic yards— _ f
Boat ramp j _..._..._. - i _. I - i ,--
Boathouse/Boatlih I—iir! -
— I —+_—T___
Beach Bulldozing ,
Other I
1 I i ail Vr'Ohl i i .
I 1 iy - I .
Shoreline Length .St 0' • 1 1 I I I j I If I l I i
SAV: not sure yes to) _ _. _ _ •
I"Sandbags: not sure yes e __. " i t..?4l he fe l a-
Moratorium: n/a yes ,� —
Photos: yes i • rC Jf 1
Waiver Attached: yes no -. -- I / p _
A building permit may be required by: tow P\ n O'C4-r, 4-�+5‘� �P f�{� I .See note on back regarding River Basin rules.
R Notes/Special Conditions '' Con 1
d f ["iOn S of �e c-h o r1 '7 4. /200 !j r. FiUA±
1 U , L, . rrl 1; (\CJ IoJJ1 -, f 1$•'eu t CI0C LS ' Al() Matt A-r) fA +01 4 / Uf
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All �b -moorc-ci a+ this SfruCh4rc.....)
-1-ket• rn OD
Agent or Applicant PrintedNamel T/� a is Signature 1(p
-1 -03 �-
ZiZ/6,./.&_:y
Signature Pread co iance statement on back of permit'i's' Issuing Date Expiration Date
Application Fee(s) Check# Local Planning Jurisdiction Rover File Name
.-L..W<w..I.al..A&.• —_ _ - iii - �i,.•,.....i ts. �.ii-----]Yida=i—_=_. . • - —�YAM...a'1:.v11h F41114

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
L.Tar-Pamlico River Basin Buffer Rules Other:
I Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office(252-946-6481)or the Wilmington
Regional Office(910-395-3900)for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District Washington District
Mailing Address: 1367 U.S. 17 South 943 Washington Square Mall
1638 Mail Service Center Elizabeth City, NC 27909 Washington, NC 27889
Raleigh, NC 27699-1638 252-264-3901 252-946-648 I
Location: Fax: [phone] Fax: [phone]
(Serves:Camden,Chowan,Currituck, (Serves: Beaufort, Bertie,Hertford,Hyde,
Parker Lincoln Building
Dare,Gates, Pasquotank and Perquimans Tyrrell and Washington Counties)
2728 Capital Blvd. Counties)
Raleigh, NC 27604
9I9 733 2293 / 1 888 4RCOAST Morehead City District Wilmington District
Fax: [phone] 15 I-B Hwy. 24 127 Cardinal Drive Ext.
Hestron Plaza II Wilmington, NC 28405-3845
Morehead City, NC 28557 910-395-3900
202-808-2808 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Carteret,Craven,Onslow-above Onslow-below New River Inlet-and
New River Inlet-and Pamlico Counties) Pender Counties)
www.nccoastalmanagement.net Revised 10/05/0I

GENERAL PERMIT COMPUTER FORM •
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APPLICANT NAME: 1' ►
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ADDITIONAL NAMES:
AEC DESIG: _ P T DEVELOP AREA: _,0 I PROJ DESC: Q - 12.
(Will only take 6) • (Will only take 1) •.
WORK: c r L4k )Co
(Will only take 4)
'T.a )(. 20. •
MAINT: •
(Will only take 4)
•
IMP: ('(A) (04 •
(will only take 6)
0w l(o0
ACTION EXPIRATION
DREDGE&FILL REQUIRED: =1 Co-03 l Lo"O.3 '
CAMA MAJOR DEVEL REQUIRED: 5 Ito'03 8-1cp-D3

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SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
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m • Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. < j 0 Agent
■ Print your name and address on the reverse X i
■ Addressee
so that we can return the card to you. B. Received by(Printed Name) Date • I
• Attach this card to the back of the mailpiece,
or on the front if space permits. I
D. Is delivery address different from item 1? ❑ Yes
1. Article Addressed to: If YES, enter delivery address below: 0 No
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g .��0 0 ❑ Certified Mail ❑ Express Mail
1:1Oa 1„ •' V �"1 �r� ❑ Registered ❑-Return Receipt-for Merchandise I
,, ° �• " _ r ` l ❑ Insured f .°' ❑ C.OifJ. ;- _
os ; o ` �� y • • i 4. Restricted Delivery? (Extra Fee) CI Yes y
a i •i !
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v � •ma '��e4 r i * ' 7003 050 •
0 0003 3321 4014
v� u n d cti _ .
; service lab 102595 02•M 1035
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I -� ; , August 2001 Domestic Return Receipt
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"vi 1"-...-o - �� of 1- - ' B;o
n U a LL 2252 EON..h`t0h 22EE E000

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NI SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
cn
t ignaure 7'
• Complete items 1, 2, and 3.Also complete A. S AP i ❑Agent
item 4 if Restricted Delivery is desired. ����,�! ❑ Addressee
o • Print your name and address on the reverse
so that we can return the card to you. 'eceived by( rioted Name) • C Pate . el' ery
m _ • Attach this card to the back of the mailpiece, " 4-5y
/4 a' /LG 1r-mom
or on the front if space permits. D. Is delivery address different from ite. 1 .a Y
1. Article Addressed to: If YES,enter delivery address below: ❑ No
,Vi'/21`,W. .
C r.• �ti 3. Sprw pe
a) --' . , `ij C ified Mail ❑ Express Mail
o •
©Ce/7�v `�i 4 „ _ „' v r:. 17-// nistered ❑ Return Receipt for Merchandise
o 4-Ensured Mail ❑ C.O.D.
o ..075/ 4�Restricted Delivery?(Extra Fee) _Yes
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3 2. Article Number
7003 0500 0003 3321 4922 . .'1 .. . .,
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(Transfe r from ser
PS Form 3811,August 2001
Domestic Return Receipt 102595-02-m
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nTVTSTOT OF COASTAL_KANAG r
. A.DJAf FNT RTPARTAN PRQvERTY OWNER NOTTFIrATION/WTATVER FORM
Name Of .Individual Applying For Permit : Kekl2le
Address Of Property: 3 ( Cuvxn ; f—
(Lot or Street #, Street or Road, City & County)
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 description or drawing,
g, with dimensions,
should be
provided with this letter.
I have no objections ec� bons to this proposal_
Tf von have objprtiolts to what is 1_oin nr
Division of C'oasi'al Mara Pm�nt- g_ ohs d' p� FasA writA t-Le •
g , 127 Cardinal Driv Ext-onsioi,
Wilmington, North Carol ina, 2B405 car coal l 9 I 9� �4� wi t-h,,,
FIRys of rpnpint- of this not-i rr No ram, , e
Spc�nSa i s runs; riAred the Same
aS no objPrt- c on if you havp bElPn not-ifiPd by rarti fi Qd mil
WAIVER SECTION
I mnderstand that a pier, dock, mooring pilings, breakwater, boat
house or boat 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. )
1 do wish to waive the 15 ' setback re ire
qu ment.
I Flo not- wish to waive the 15 ' setback requirement.
/1 /l0%3
Si I� ue — Datei*C
Print Name ®'
336 — /-tr —gr.
Tel Number With Area Code
NCD N
E ;L.
NDR-TH CARo1JNc, An"TtNT of
ENVIRDNMENT AND N.GTuRA_F=��DIJR`S

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Mark A. Smith 66-30/531
Jill N. Smith - 062 845
Ph 643-0856 NCDL 2616033
6103 Great Oaks Dr
Summerfield,NC 27358 DATE/ �_�
PAYER THE ,+-/ - r
ORDER TH _ /� /_Yj $,[ 4:1 CAD
a
c1c) -- l ' � /riil/D D \
took for:Micr Print signature lint.gray type and linework,First Citizens Bank logo on back.If not present,do not rash.
FIRST CITIZENS 062
First-Citizens Bank d Trust Company
Greensboro,N.C.27402
FOR.__ .�� �rP0 B
( � 3Y17m.
• 1:053 L003001:0006 269370480 0084•
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