Smith, Jeffery 84843C

AMA ❑ DREDGE & FILL N9 84843 A C� D
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GENERAL PERMIT Previous permit
� ti Date previous permit issued
ew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As auth zed by the State of_North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 1 r^�S - UV _ Rules attached. Yeneral Permit Rules available at the following link: www.dec.nc.gov/CAMAruies
Applicant Name Authorized Agent r �' c� J A
Address G^ / pIl t► a 1
City _ . I td4 U'u State ZIP
Phone # ( )
Email
Project Location (County):
Street Address/tate�oad/Lot #(s) _
Subdivision
City _ LV C.ti7 . d .ti ZIP
Affected CW , I EW — TA ES ❑ PTS Adj. Wtc Body l J at1 n/unk)
AEC(s): ❑ IDEA (`❑' IHA ❑ U W ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body <'Ad /un _ _
ORW: yes01 PNA: yeylno J
Type of Project/ Activity
Shoreline Length 1 f j
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s) /
Finger
Total Platform area _
Groin length/#
Bulkhead/ Riprap length _
Avg distance offshore
Breakwater/Sill f
Max distance/ length T
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit
Permit Conditions _ _ I ,,
no
no
no
no
be required
_�✓1fY12�/ ,_ e�
('..'LIAox)(
(Scam )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I_AM A1WLARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWE MPLIANCE TEMEENNT_. (Please Initial)AA
Y �TOtl yin it cochli''an "IXI'E-rlt�r`=
or Applicant PRINTED Name Permit
`Please read compliance statement on back of permit* • Signatt
--
n Fees) Check q/Money Order Issuing
Date

`OASt4l AMA ❑ DREDGE & FILL ITT° 84843 A C D
0
Previous permit
ay GENERAL PERMIT Date previous permit issued
ew ❑ Modification [-]Complete Reissue ❑ Partial Reissue
As auth , zed by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 1 �L UtJ ❑ Rules attached. Yeneral Permit Rules available at the following link: www deq.nc.gov/CAMArules
Applicant Name
Authorized Agent
Address
1—I VE-e U �J
Project Location (County):
City c +~
U''U State V—CZIP
= t,
Street Addresss/State�oad/L t #(s)
'^i
Phone # (
C lz %
Email
Subdivision
City 'U
ZIP
Affected ❑ CW
PTA ❑ ES
❑ PTS
Adj. Wtr. Body
at/ n/unk)
AEC(s): ❑ OEA
❑ IHA❑ UW ❑ SPIMA
❑ PWS
�
Closest Maj. Wtr. Body V
ORW: vesdno )
PNA: VeS/no
Type of Project/ Activity
Shoreline Length 1 ,
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
OKL
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zoning I
Permit Conditions
yes no
yes no
yes no
yes no
be required
X'S--' de
0 / Z cl ov,, "-d" L—
Y'f
't
4,-"L 1 � ox) t�- d ,
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(Scat%f7— )
C-Al
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED MPLIANCE TEMENT. (Please Initial)
e---- /I
gen or Applicant PRINTED Name Permit Offic 's P NTED
Sig r **Please; read compliance statement on back of permit** Signature
A tion Fee(s) Check #/Money Order Issuing ate Expirati n Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms4nay
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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar - Pamlico River Basin Buffer Rules F-1 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 Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTMaRiZA'tIC? t FO AMA PE RArr A poi iCATiON
i
Name of Property Owner Requesting Permit:
Mailing Address: -i o +a 1-11'eiost-k Lant�
4_3yV,AnSbO YQ4
Phone Number. _ 81�k '1439- -7-75' }
Irmal( Address;
I certify that i have authorized Y
Agenirconiractar cochr�r,
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: (',n�4 rks
GG o--ncj-tt!�, ci n r,
at my property located at t O 4 I_, h P jjQ gj r
in __Qr1S1QyV County.
I rurthermore ceriffy that Tam 84ft ked to grant, and do in fact_ grant permission to
Division of Coastaf Management staff; the ocai Permit Officer and their agents to enter
on the aforamentioned lands in connection with evatuaiing information reiated to this
Permit application.
Property Owner information:
Ji�YP,! OY���YYt Smi44 ti
Pnntor Type Marne
Title
V
pate
This certi afion is valid through

ADJACENT NER STATENT
t
I hereby cerUN that I own property adjacent to
Property located at Lq (Name of PCoperty Owner)
on ; Address, Lot dock, Road, etc.)
(Waterbody) an . t i S bn1-C3 / a t Eni N.C.
(City]To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loce '
1 have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION AtdWOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing devegapmeni must M in descripffon belOw or armch a site drawing)
i understand that a pier, dock moori V R spCTinm
P9 PHtr , boat ramp, breakwater, boathouse, rift, or groin
must be set back a minimum distance of is' from my area of riparian access unless waived by
me. (if you wish to waive the setbacl you must initial, the app
Mriate blank below.)
1 do wish to waive the 15' setback reqtdrement,
1 do not wish to waive the 16 setback requirement.
4 eriy Owner I"f adore) (Ad t Pro
Rs �er I formation)
Print or —
i Ype Name r)P rir,i� t1 r (� P- t h0rn
JoAa Line �# trfr��; Arintari"ypeName Mai/Ing Address �-�.'s +n ��
Swgn51poro1 NG 2$a$4 tWailingAddMw .t�
City/3tate2ipwc�riSboYp r•i� ZS�y
j itylS i�lZ1p
�elep one lUumberl email address "r /` ' Z!o 5 S 5 $ j ti'�r,W� s �%a r �..� r,{ Lriry A; �, t �w
Tele hon Numrlemail adds
Date- - ---.. 2 t
'Valid for one calendar year after signature- (Revised Aug 2a14)

A JACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacentto Jefg— . at-NCl %ry'l Smith
Name of Property Owner)
property located at l Ol.� L.; r,� [�c„�c�lr �.-� c1n�
{Address, Lot, Block, Road, etc.)on white cqK I
�, in SwanSbok-r {n&1 o ram , N.C.
(Waterbody) n (City/To andlor County)
The applicant has described to me, as shown below, the development proposed at the above
1 a on.
I have no objection to )his proposal,
I have objections to this proposal.
DESCRIPTION AND/OR DRAVWNG OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER ECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 trust initial -the appropriate blank below.)
x I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
rl
Prim or Tyne Name
Pent or Type Marne
1O_1�iYt.(' �iAA F t gnf:
Pn Rnx 22-1i
Mailirrti Address
Marling Address
13WcgnSbor0, NC", 2$5�'�
��rSSbbrn s.�r 2,4�5��%
City/State2lp
'7
cityl&atel ip T
913 - 59 - -7 7 51-4
Telep one Numberlemafl address
Telephone Numberlemali address
4L'� `� f� _ J
Date
Date's
"Valid for one calendar year after signature'° (Revised Aug. 2074)
If:�

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