Smith, Mark 88854C

t°A'"' ❑LAMA ❑ DREDGE & FILL N9 88854 A B c D
GENERAL PERMIT Previous permit
y
:�§`❑New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
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:
15A NCAC i❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:)' )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
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
r+'
SAV observed: yes nc
Moratorium: n/a yes nc
Site Photos: yes n(
Riparian Waiver Attached: yes nt
j , n
A building permit/zoning permit may be required by +��_�'''!"��
t ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions 5,
i� jL� ❑ 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 COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels)
Signature
Check #/Money Order Issuing Date
Expiration Date

a1°1`°"Sr4l ❑CAMA ❑ DREDGE & FILL Nd 88854 A B C D
y =GENERAL PERMIT Previous permit
J Date previous permit issued
New ❑ Modification [:]Complete Reissue ❑ 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 SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP "t t Street Address/State Road/Lot #(s)
Phone # (_ )
Email Subdivision
City F i' ?: ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) /
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: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit may be require
Permit Conditions'' .
(Scale: )
d
by:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
L� (f ❑ 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 COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
LQL%rd `'%ilor
9/ V- .5"3 a -�74�
��`'�Nk �l"G 1 � u� �✓ ��KS / /G/'Jr7e �2�"
Agent'/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: J6k1k
z.- 1X15 �I
at my property located at 2? 16,9
in ��'� 1-e.-I�- County.
I 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:
/-r -j L
Signature
Print or Type Name
6L"L) /p (,- /
Title
l OfV 1
Date
This certification is valid through J / <3 / 1-23
RFCFIVED
iDCM-MHU CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion too be completted by owner or their agent)
Name of Property Owner: / `A� �� ✓ J m
Address of Property:
Mailing Address of Owner: Lg u r _-�2 74, /2—
Owner's email: � �%/s3 %/7�, �r<GC` wner's Phone#: / j I ' >J,;), -VTR
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.) -Z i
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Ribariah Property Owner
-0 R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Prop�rty Owner:
ltj(
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
RF Fr)
JAN 10 M-3
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property:
Mailing Address of Owner: 3 //4 % Y)r rtc�:- ct'�� 5~h, !✓� .��(o /-Z
Owner's email: Y�'i..5)�-►r rh vj/5��'n�a rrn <`�wner's Phone#: '%%-
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback /�. Jl1 (� 4eM
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO: NV -CV) v 1 �Tl K-4 n -( C
Mailing Address ofARPO: 0-0 1 l f7✓()n�'/' 1 `xaIJ�W
ARPO's email: k,,,k L,. %.. \. u'� -\ ARPO's Phone#:
Date: i <i I�'t-Z" .waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
JAIL 10 2U.

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CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious
email as an attachment to Report Spam.<mailto:[e-mail]>
Wayne,
Here is a sketch of the proposed project, although my scale is a little off. The width of the existing finger
is about 5'. Thanks and let me know if you have any questions.
Mark
Sent from my Phone

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ...A�`►1I +L
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
M 163@ Nt.W,(0M
tj c_<f- Ls� -
Agent /°Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAM pe mits
necessary for the following proposed development: <—_y' `
at my property located at SL v
in County.
1 furthermore certify that 1 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:
Sig ature
y
z�
Print or Type Name
Title
Date
AV�f� (C) ` � q (6
This certification is valid through 1 / :. ;

STATEMtN i 11 .
gj}JACENT RlPAWAN PROPERTY Ow1LNER .
s
a r)
I hereby certify that 1 own propel adjacent to ame Prop rty owner)
property located at ess, t.o Block, Ro �, N.G. .
1 in �� a�
(Cityrown ancUar County)
on (WaterbodY)
nt proposed at the above
applicant bed to me, as shown below, the devel c n
The PP has descri
to .on. d ,o bjection to this proposal.
N 1 haveyul—� >_
lON ANDIOR DRAWN OF PROF below f attach a site drawing)
DESCRiPT meat must riff in description
(Incfrvidual proposing develop
Ircne-
tN�, ERP,
VqANER SECTION .
groin must be et
ilin s, breakwater, boathouse, lift, or y�
pier, dock, mooring P n � of riparian access unless waived by
-- - i understand that P rooriate blank below-)
back a mi imur?} istance of 15' from my
wish t wive ` se u must iriitiai the aPP AUG 2 5 202?
do wish to waive the 15` setback requirement
�' setback requirement-
1 do not wish to waive the 1
DCM-MHD CITY
Ad•acent Prop Owe er ormation)
Print or Type N
IN.drrrC I r, (A '�i ,e- 0
Tele f
',o
1!
Si
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'201 ?J

STATE►uttN'
pDJAGENT RIPARIAN PROPERTY OWNER 's
scent to �` Owner)
that l own Property adj � ame � proper°tY
C ,_ �' etc.)
property located at (A, �o Block, Ro N.0
0 e &A �C
(Gl��o'"n andlor County)
on (Waterbody)
o me, as shown below, the development proposed at the above
t
The applicant has described
?� location_ prop osal.
1 have no objection to this p P f-
--_---
-- -- ION A3tID10R ORpy�NG 0� PROP on Belo aftachEa site dra�rin�}
pESGRIPT
lndtviduat proposing development must fill in des -MP
a
it Z 1
9
WAIVER SECTION . roin must be et
flings, breakwater, toathouse, Iift, or 9 m�
pier, dock, mooring p area P
-- -k understand that a p of riparian arian access unless waived y
back a minimum distance Of 1 must initial the appropriate blank below-)
wish to waive the setback, y
ou _
setback r�q p uirement. CITY
1 do wish to waive the 15`
l do not wish to waive the 15 setback requirement_ er Intorrnation)
_-----
A dl' a cent Propel
propedy
a
Print or Type Name
T% 1r",rl e'0
Telephone rvul-1 ,
Date
1
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Print or Type �1
Ad ress
�- State/Lip
Te phone Number .,
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