Smith, Claude - 88978C

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❑CAMA ❑DREDGE& FILL N9 88978 A VC' D
GENERAL PERMIT Previous permit
Date previous permit issued
❑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
I SA NCAC Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc goy/CAMArules
Applicant Name .I (:%ll•ICI{_' `-'�YYII� �'\
Address i .1 ,'4� �iJ•.
City State ZIP :7.)':2.1C
Phone#(' ) /i-`1(
Email
Authorized Agent
Project Location (County): C Cy )-CV c A -
Street Address/State Road/Lot #(s) '-! jL <_:P'g<A1LVr h'V
City /,i' ,i6( w, `,, 1(, ZIP 2-L I
Affected CW ❑EW ❑PTA ❑ES ❑PTS Adj•Wtr. Body u�..\iYl>Yl f�C1\i Cayman/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body C Uxe r.>UG1Y\C�
ORW; yes/no PNA: yes/roll
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Type of Project/Activity 2V'L')LSf&A C�L k. CII-V� I+IIi"f<�
(Scale:"[ 0 j
Chnrclinn I nnoth
Access Length Ir k 1>!(1 `
tt I
Pier (dock) length (< tt 7
Fixed Platform(s)-
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FloatingPlatform(s)
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Fingerpier(s)
T.
Total Platform area I I (i
Groin length/p %'
Bulkhead/Riprap length
Avg distance offshore
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Breakwater/Sill -
Max distance(/ length 1"Vrrh N6-'-
Basin, channel
Cubic yards/-
Boat ramp
Boathouse/Boatlift1
Beach Bulldozing
Other
�y_
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v,
SAV observed: yes no :I
Moratorium: n/a yes no
Site Photos: yes no tC
Riparian Waiver Attached: yes no
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A building permit/zoning permit maybe required by: i i i
L 1 .�, [ ❑TAR/PAM/NEUSE/BurFER(circle one)
Permit Conditions ttClt lA I11��19t1CA -�ii(; Cr � !`L `f (":T� �5��� _.C(1?
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F{.Vj ❑ See note on back regarding River Basin rules
{ �� P clnkXl-1'n}f
- ❑See additional notes/conditions on back
1 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" Signature
Ap� ication Feels) Check Jt/Money Order Issuing Date Expiration Date

Atom?" ❑CAMA ElDREDGE & FILL NO 88978 A e C D
APrevious permit /
. GENERAL PERMIT 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:
15A NCAC i ❑ Rules attached. General Permit Rules available at the following link: wwwc1eq.naeov/CAMArules
Applicant Name Authorized Agent ��T_rvll I--'li,•..'� 'i.V P;
Address Project Location (County):"�-
City State ''i. ZIP Street Address/State Road/Lot#(s)il/_. I rl'_)l, ,r
Phone # ( )
Email Subdivision
City •AA V it 1) ICIl. ZIP
Affected ©CW MEW ©PTA ❑ES ❑pTS Adj. Wtr. Body 1-`.i� ( � I V.!\ I (nat/man/unk)
AEC s : OEA IHA UW ❑ ❑ ❑ SPIMA ❑ ❑ PWS Closest Maj. Wtr. Body i ,l
ORWiyes/no PNA: yes/rio
Type of Project/ Activity
t _
(Scale: )
Access Length !
Pier(dock)length 1
Fixed Platform(s)
_777-1
—
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-
—
-
—
I
,
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--
I
Floating Platform(s)
Finger pier(s) /
TI
- _
Total Platform area
Grain length/H�--
Bulkhead/Riprap length %
Avgdistanceoffshore -
Breakwater/Sill -
Max distance/ length
Basin, channelF
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
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-
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-
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—
—
—
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SAV observed: yes no
Moratorium: n/a yes no iL
Site Photos: yes no
Riparian Waiver Attached: yes no
—
—
'-
._
A building permit/zoning permit may be required by: i I it l \
❑TAWPAM/NEUSE/BUFFER (circle one)
Permit Conditions
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
Signature **Please read compliance statement on back of permit**
Application Feels) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at !(IX
Ssa c (� ✓e l�r. �r
r� (Address, Lot Block, Road,
on Core Sterb .rjC , in �1 / C ` N.C.
(VNlateebody) I(CtrvlSqft and/orCounty)
he applicant has described to me, as shown below, the development proposed at the above
location.
G_I!—,_ I have no objection to This proposal.
DESCRIPTION AND/OR DRAW-,ING OF PROPOSED DEVELOPMENT
(n.diriduai proposing d/e/»/�•{opment must fill in descr orr on belour attach tr wl.0)
• v . ✓/ c
Li `i<3 L.
RAJ -ER 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.)
do wish to waive the i 5' setback requirement
9 k I do not wish to waive the 15' setback requirement.
(; r�o°p9e^rty Owner inform(attiion)ry�, -
r ty r Information)
;(Adjace
Signa/lure k S
tature
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Pnnf or Type Name
A(oyf2 &�! Ge,wo{%FA Dr. '<
Print Tyr LNa"
3ra �a a`
klaning Address
_n4ailing,Addre
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city/Stafeop
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Telephone Number
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Telephone Al_
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(Revised 6/1812012)
RECEIVED
AY 17 �023
DCM-MHD� CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
A1... - -f D---. , rlunnr Donuoclinn PormilI . IQ." Ub P. k 5' V.iI
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Mailing Address' 9 O Z �� �r,,olfr44-er�:)H
Pkgi-hr*ei NG a-VAI®
Phone Number:
Email Address:
I certify that I have authorized K` a rs L- AwPP� ae_
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all i/�CAMA permits
necessary for the following proposed development: ,/N-SA Yr P-0
.
at my property located at `7 12 �r+J'#. -DA aAP -,��
in r- Cam' County.
1 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
Print or Type Name
C7w�e�
Title
3
Date
This certification is valid through r l r lA
U
"Y 117 2023
CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to a
(Name of Property Owner)
property located at `f/i S<as {b✓� l�r vs
(Address, Lot, Block, Road, atc )
an �'or4e Sm.......IQ , in A±(�.,(- ' / C A,, 4-. N.C.
(Waterbody) (CitylTq rn and/orCounty)
The applicant has described to rhe, as shown below, the development proposed at the above
location.
!tit I have no objection to this proposal.
---_Jhalte_ovjQsiioas32ttils_profxosal�.--- -----. -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below pr attach a site drawing)
osf QovlR prr '�ps
�t - . rase
goXao . �'
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[.understand that a Per, dock, mooringg -_ - , or 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 lnttial the appropriate blank below.)
do wish to waive the 15' setback requirement
AS l, - I do not wish to waive the 16 setback reauirer
(Property Owner Information)
/
SiP
re
k C , k
4
Print or Type Name
12042 Pe' '
MailingAddre s
r d L- Ne 2fZ-1D
City6tele2ip
/.9?A Jura gdca
Telephone Number
S=S= Z3
Date
Late
(Revised 6/1 &2012)
MAY 17 2023
DCM-MHD