85624D - Smith

3��`°"r'� I LAMA DREDGE & FILL No 85624 ABCD
i ,GENERAL PERMIT Previous permit f.
Date previous permit issued
New Modification n Complete Reissue I I Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I 5A NCAC ( '.i H. • I Rules attached. [] General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
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Applicant Name II ' r`r / � I Authorized Agent / i""
Addres,) \%A lO . 610 J 1 M /nl( t),A.(i1 N Lb• Project Location(County): r2r.►4-City -
r7u`A.vI (Ik-. state @ ,�, #(s) to .5 N • k 1�- ZIP ��� �C Street Address/State Road/Lot �y�-�... �5�� �T;I
Phone#(- )2 1 "3�j" -�" , c�:_._ 4= ' )U 15t�l�ft 1 ES
Email i5 t7'''/ 1 l i*L�64 1(161.1) • '0 PK. Subdivision
City PO(A,,Jl ZIP 1-(p 5 kK
Affected n cw [ EW n PTA la ES PTS Adj.Wtr.Body 1-'1/4. w Cf . ., , .9a unk)
AEC(s): III I"'OEA IHA UW n SPIMA i l PWS Closest Maj.Wtr.Body C (.f �•
ORW:yes/no PNA:yes/no .)
Noe of Project/Activity 1 A t;4 R 11 (oo6_1 rex-iA-
( (Scale: n fts )
Shoreline Length rt r- CSC', 1v
Access Length - ___.1,
Pier(dock)length1 4
Fixed Platform(s) I_ - I
Floating PlatfoCm(s) � � ! i
Finger pier(s)
( .1I
Total Platform area '', ,, 111211Miriall
Groin length/# ..- -..-�` •..�� or i'i 0 —
Bulkhead/Riprap length
, 1
Avg distance offshore kk{{ {■y^'
tl
Breakwater/Sill --1 MIN -- I - am® - '
Max distance/length
Basin,channel
I I_
Cubic yards 1 �.._
I
Boat ramp , .I / .� 1 _
Boathouse/Boatlift f 1
Beach Bulldozing
._ .-._
1 Ada
Other I
��- i
}
observed: yes
1 f
SAV
Moratorium: n/a yes •011
Moratorium:
it � ..i
Site Photos: Ye-4-. ! ; . ._....._._...._._..... ...___�.
Riparian Waiver Attached: ies�.,no Al{ 1 ! I j s t ( ,
A building permit/zoning permit may be required by: l F N j)E#- W
Permit Conditions TAR/PAM/NEUSE/BUFFER(circle one)
nSee note on back regarding River Basin rules
nSee additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
1 Oh'v` i t % 10-11-21
\gent or Applicant PRINTED Name Permit Officer's PRINTED Name
i 122

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"IICAAAA i a Flay & 4 e
'GENERAL PERMIT Dote priwious permit -
Oji New °Modification ['Comp( Raiff CDPartial Reissue
Si otiksAtufk,the of North CargW .Qtm ert."1"1 d E n.ItollrrrMsN,l 1)41114r, t d test Co.r,f Aele"1 n C"'"414
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of a.MrorsMantal wrscrn PIIIIWW tdo:
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I itiati,a44 Pip ►►ow.,Go-aran{Lowo) __.:.._
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5rreet Rout/Lot - �! t! .�l•'.
!hood', IF4iLt%Ui
of " ._1
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city-- �� -- Lh //��� - __ -ZW `6 V'_
Ni roe flow ..�ew ri V PTA �E`S A4.W t ode ._.C. ._.__—_____-___- / ,: i ,NA I.._"ow I'.1SPIMA trots Cwstu tMq.Wm ear, . . 14.E-.._
�EG3! DEA pins
asw.Yr PNA miff:,
rTPe of Pro)ecef ActOvt4 __ ____-1 — —C —
--t—_.._..._.__ (Sale:iviz)
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.rea _tldr __r aw krgth.:e o.MaAarr tr`Srf1 _- _.® F.+:ci wmcit.� ,�.,sN_
61.001.a4W ecathtt
bescl. ± iiiiT:
_... ___._ _.,
Other
SAY ,�� N�01
Alcxnlanutn: nja 'MS 5ito I�"
SaePhotrr.. r
Riparian warrr ilriachrd s"
A twiiduig pelmf.forunq proof c, v be rrr:nred br _._._. W pe 3eo__L_ .
Pf+md fOndNgrlS _ .._
.
C TAR,PAMNIEthEiBUFFERictrcieone)
nSee note on bad regarding Atvtr easin rule
__.,_.__________.___________..—___,. _ ��See add+tionalrsatei/condtlansonhack
I of STAT f ES AND CONDITIONS THAT APPLY TO THIS PAOA:CT AND PINK OMPLiA E STAT1M4Pil. 1Pk•se tn:hait
ay(p MINTED Hest Perm er giNTED a:M
tr."•eerier <r+mptieXt$144Prn,nt h,:k cf C-err Srtneure

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: - -obi r3 As. S vv4-:`P1
Mailing address: 11 6 ( I, . C.hinqutito rt L L
ec.c.(a.v�lfle_ 1\h UDZ�sig
Phone Number: 01 D ) 3►GD 3 f g
I certify that I have authorized I I.hi�. l
Agent/Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of (t\JiwU- 140 l!J kSh eUer Esfate5
at my property located at lV6,r-+1, 14,311 u 6tne,I er E fa-es Rct Li I
in � �/' � County.
This certification is valid through
Date
(Property Owner Information)
IL% Q
Signature
n013 iN Cy 5 jYl 1�h
Print or Type Name
Title
7— a-p- �2\
Date RECEIVED
91U - Aq0 -33-78 SEP292021
Phone Number
r �SYYt ! t. 19104 l e'loud . Ceitri DCM WILMINGTON, NC
g Email Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
• DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �n 6 rl
Address of Property: Norte Etbl l .ke.:110r t51 S(I„a�-]a)Rode Jr-1l.►J, e- R er 6 c.
(Lot or Stet#, Street or Road, City&County)
Agent's Name#: Mailing Address: ID i r •
Agent's phone#: I c��a v�j j� /'J Z51 R
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, with dimensions, must be provided with this letter.
7 I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management(DCM)in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC,28405-3845. DCM representatives can also be contacted at(910) 796-7215.No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.)
-77 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
PirtAri, ATA
Signature Signature
Qo.h w G 5m% 5Cert
Print or Type Name Print or Type Name
Inv
ew
Mailing Address i P Mailing Address •
,iJ‘LIUlA\G Y Roeky 2 t5?
City/State/Zip City/State/Zip
91 o- o -33-7 g 9/ -Y62225J RECEIVED
Telephone Number Telephone Number
I- �!to _ z 1 • 7�26�4
SEP29 "' 2i
Date Date DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY 1-1 (W OWNER STATEMENT
• • I hereby certify that I own property adjacent to Hobs :i- 6yti q-in 's
( ame of Pwerty Owner)
property located at for )4-DILL(l� 3 d fu- ESfa Fes J..tt B Kd-•
( (Address, t, Bloc , Road,etc.
on J Ur En.51- Cape Ica.- , in i 111 d 1.1C`� CD- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
i14 Feel w►d6
-c
1,wnd 3
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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 do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Si ature +I Signature�,,�/ �
Signature
IN Cr,5r i /` ht, �-""' 1 J
Print or Type Name Print or Type Name
1u91p ol-d ckiAt li w 3' i tfen, S ' 7 3WC id.
LMailing Address IVI ling Add/rgss , 7 7
ei kuilt<. NUC.. a.i)Yle 1a�r& /'_ ,A f I I" �" `���/
Cit / i Cit tat Zi
�State2 p � p
9IQ -'k9d - 3176 To er zzsf RECEIVED
Telephone Number Telephone Number
1- .1(o " ). 1 ›..z-6--Ze,q
Date Date SEP 2 9 L0L1
(Revised $ QIMINGTON, NC

Check
Date Received Date Deposited Cheek From(Name) Name a Perm"Hope Vendor Check number amount Perms Number/Comments Receipt or Refund/Reeaocetut
Cokannl Column2 Column] CaNnM Columns Columns Column? Column!! Column➢
10/12/2021 10/13/2021 Delta Dock and Boatlift John Weeks First Citizens Bank __ 9167 $ 200.00 GP#856350 JO rcL 15587
10/12/2021 10/13/2021 Robin Smith same First Citizens Bank 9839!$ 200.00 GP#856240 JO rct 16009
10/12/2021, 10/13/2021'Richard Renny Construction,LLC Wally Diehl NAVY Federal CU 15801$ 200.00 GP#856220 JD rct.16006
10/12/2021! 10/13/2021 Jerry Ennett Michael&Jennifer O'Donnell Coastal Bank and Trust 41831$ 200.00 GP#856230 JD rct.16008