Smith, James 77186C

V
CA MA / ❑DREDGE & FILL NO O 77186 A B C D
NERAL PERMIT Previous permit #
'Nev ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �+y�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attache .
Applicant Name :UIRProject Location: County ro
Address V Street Address/ State Road/ Lot #(s) ���7✓� p
City i 4 State ZIPS
Phone # ) P E-Mail Subdivision
Authorized Agent City ZIP
Affected ❑ CW �•• �TA El ES ElPTS Phone # ( ) River Basin ,
Affecte ElOEA [IHHF ElIH ElUBA El N/A Adj. Wtr. BodyIs nat /unkn)
El Pws: �,
ORW: yes no PNA yes /0 Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length --. — —
Fixed Platform(s)
1 i ; - �❑
Floating Platform(s) f
Finger
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
T
Basin. channel
cubic yards s
Boat ramp
Boathous oa t !/3
l
Beach Bufldo�fzin
Other7 C} R 7
Shoreline Length
SAV: not sure Jyes
Moratorium: n/a
Photos: Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Fondjtions ,
0. ►"b
Age or Applicant Printed Name
KS
Sigp,ature PI@ase read compliance statement on back of permit **
a6 a��
Application Fee(s) Check #
(Scale: /'11t )
❑ See note on back regarding River Basin rules. �-
1 / )A li-1 RCw4 cA D 1

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 64'1,e3
s:x
Mailing Address: 106 Ak0 le- G4
Pe?4-&1oa t /V(- v��i�
Phone Number: 2 So2 a U V//
Email Address: CY-i,� S�s,�'h @ (�; aeS T • C��
� lo L
I certify that I have authorized /I f�. t,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: % 0 0, -4
at my property located at
in G1(4e_� County.
l furthermore certify that I 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
i e y C -.&,' rV
Print or Type Name
Title
c l �10 / 0
Date
This certification is valid through

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:--%4��s e • S ,;
Address of Property.- 1 o6 �1/,
AJ,
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Lj b� Mailing Address: 3 yi3 v%J Ak�,,f2u
Agent's phone #: 2> a S L% 72s' 1l%`'� �a-J /✓�- �BjC� -
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.
104 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. Contact information for DCM offices is
available at http://www. nccoastalmanagement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST.
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, 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 do wish to waive the 15' setback requirement.
t t I do not wish to waive the 15' setback requirement.
(Prope Owner Inform ion)
77
nal-ure
Print or Type Name
Mailing Address /
1 , // Sir arts �� ' QS%L
CitylState/Zip
Telephone Number/Email Address
/°_2���
Dale
rian Props Owner Info ation)
l.� 6 DCl
,S'l,�,llullu � 1T11 OM a,(
Print or Type Narde
P."
Mailing Address
oa_CQ 1_�_
City/State/Zip
a sa- -- 91 b
Telephone Number/Email Address
o f3 3 - - -- -- ----
Dale
(Revised Au0, 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
"."s 45. 5Z.11
0.
(,Lott or Street #, Street or Road, City & County)
Agent's Name #: //lwe'46 Mailing Address: �Gi�� OIc�%f � orT��✓
Agent's phone #: ;? Q?-/�65. 112Z S /"4,-v &-r'11/ (—
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.
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. Contact information for DCM offices is
available at http://www.nccoastaimanagement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST.
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, 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 wA h to waive the setback, you must initial the appropriate blank below,)
4iLL
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
gncl t ure
Print or Type Name
(Riparian Prop Owner Information)
.Sign fin
rA ,r
Print or Type Name
Mailing Ad
ess Mailing Ad�d/ress ,-
1\1L 2 G
City/State/Zip City/State/Zip
Telephone Numbe-T7 Email Address '-
- ?o- 20 ),
Owe
Telephone Number/Email Address
/0���
Dale
(Revised Aug. 2014)

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3415 CtI9 APYO f ROAP
JAMIE SMITH
106 MAPLE COURT PINE KNOLL SHORES, NC
a e:
09/25/2020
NTS
Provo
"JS-1
aram,
NSW PWN, NC 28562
2y2-665-4398
SITE
PLANS OPTION
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