91203C - Smith, Buten

dtoury CAMA 11 DREDGE & FILL No 91203 A B 0 D
LGE NE RAL PERMIT Previous permitDate previous permit issued —
ew ❑Modification n Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coas Resources Commission in an area of environmental concern pursuant to:
I SA NCAC P7/f 2/0 z/ Rules attached. eneral Permit Rules available at the following link:www.deo.ncisiv/CAMArules
•
Applicant Name sZib / Authorized Agent
Address in atProject Location(County): 0/75/_
Ci State ZIP Street Address/State Road/Lot#(s) ---'T
Phone#/� /•A� ,�p ^ �,_J_- �[
Email �LItyi/(9) p4 ehar 4/ .t7-T' Subdivision �''
City ZIP
Affected -- PTA ES PTS Adj.Wtr.Body MA"' unk)
AEC(s): ElOEA ❑IHA ❑uw ❑SPIMA PWS Closest Maj.Wtr.Body /& .-
ORW:y•CO PN/eaPho
/ // �,
Type of Project/Activity /O 3 414- ,3ii ei ,`'a S/r/
/
(Scale -5 )
Shoreline Length —'-.
Access Length -- \ i..
Pier(dock)length 1 CA)
/
Fixed Platform(s) Ole /)� �/
Floating Platform(s) I
Finger pier(s) "'''"--
Total Platform area ....—
Groin length/Si !
Bulkhead/Riprap length n Q 11 X I rn�� ��Qa lee
Avg distance offshore . / /
Sill /d'•f¢/ Q�� ! �'�/
Max distance/length y r -
Basin,channel �� ': ` - .+'
Cubic yards 1 `'` V/ 4 W
Boat ramp ~� W '/
Boathouse/Boatlift ` �{/ W J/
Beach Bulldozing
Other — �"
SAV observed: yes
Moratorium: n/a yes l i
Site Photos: I
Riparian Waiver Attached: al, no
r_
A building permit/zoning permi a bee required by: y n I-
Permit Conditions o.1 1/ Al/v �-c d _/4C'`Jer n TAR/PAM/NEUSE/BUFFER(circle one)
a Pi Ntriv, ill) Q( i, 011.5;/fr in fintkiLl n See note on back regarding River Basin rules
dv? /1L .S/-Al �
See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STAT- ENT. (Please Initial)
/,/Dhv,4',cr Gv• r,5•.n„!-iC 7/11f9 , ' ' :
Agent o Applicant PRINTED Name P mit O er's P N
Signature"Please read compliance statement on back of permit" • Signature
� tu-1�b321 L, I ► 512 Q Z 3 i 0 I t 5 / Z 3 z3
Application Fee(s) Check /Money Order Issuing Date Expiration Date

I
0"M"l �/tAMA I I DREDGE & FILL No. 91203 A B Q D
GENERAL PERMIT Previous permit
Date previous permit issued ---
" New I I Modification n Complete Reissue Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coas Resources Commission in an area of environmental concern pursuant to:
I 5A NCAC 17/e _2/0(/ Il Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name �� / (�-� Authorized Agent
Address /fo(O %fia/17/77, l k / / Pro' Location Coun��[��� �jlen ( ty)' Des/�.JCite!X:Z/LlJState /V� ZIP 1 51�, Street Address/State Road/Lot#(s)Phone# /'— ' Qn-�- _
Email yV/614 80 f:/ 2 • ? Subdivision ----'
City / a', / ZIP
Affected Y i ' 2-"' PTA /
ES PTS Adj.Wtr.Body /[ �/ cna an/unk)
AEC(s): n OEA I I IHA UW I I SPIMA PWS Closest Maj.Wtr.Body /CAL
ORW:y:41, PN /o /^ '
Type of Project/Activity /0744 3 4/ L 73/6q e{tl�"7o s/ II/
(Scale:t 1-.� )
Shoreline Length /�►�
Access Length 1 CAA)
Pier(dock)length (/t�J
ak
Fixed Platform(s) ef.S'nN._5
Floating Platform(s) T
Finger pier(s) *-----
I
Total Platform area
Groin length/# `. 4, / erPQ
—
�
Bulkhead/Riprap length f)T Q X(5� J I
Avg distance offshore Q
cZtSill IC6/-f ¢/ Q\\ e I -- - ri
Max distance/length `/ do, ._ _ - • • •
Basin,channel f
Cubic yards W �//
Boat ramp ("r ` '/
Boathouse/Boatlift r " y �V
Beach Bulldozing
Other — t t*/
l 41 \I/ -NV
y
SAV observed: yes
Moratorium: n/a yes O I
Site Photos: ,�-y ® I Riparian Waiver Attached: (1�' no C/ 1
A building permit/zoning permi ma be required by: l�1DG
Pr if .Y 1/ ,( of , ,1 ee.� /„/72ceeo • n TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditionst/ c� �/ w G,v / ,�/ L'/ � ,�/
td�2/2. A i N baLL- i4 I/ t2/$J I/f �� �L7QS //t.�/! n See note on back regarding River Basin rules
o/e pA/fL2 74-u s*k✓ifte's
nSee additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STAT ENT. (Please Initial)
Agent or Applicant PRINTED Name P mit O er's PrNT� /
Signature**Please read compliance statement on back of permit** Signature ��!/
09 �s 106'�f32I c, I15 jZOZ3 i0 / 15 /ZGZ3
Application Fee(s) Check /Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
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:
Tar- Pamlico River Basin Buffer Rules 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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

,�°``m/4,NI ICAMA DREDGE & FILL No. 91203 A B c` D
. = GENERAL PERMIT Previous permit
Date previous permit issued
n New n Modification n Complete Reissue n 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:
1 �l
'
I5A NCAC /r f. _/OC/ n Rules attached. .P1 General Permit Rules available at the following link:www.deq.ncgov/CAMArules
Applicant Name
/-� / -�) )// ( j Authorized Agent
Address /if T ,/6 k7 ,,-i ii��o_ _ / i I���'` Project Location(County): (7/%`;/�.J
City ' 1 1 C/s/ State / .k. ZIP GC) ( - .) Street Address/State Road/Lot#(s) --
Phone# / 34 5-5
Email /V/J 803 G_% 0 ha r/&" •/)+ Subdivision
City - - ZIP -
Affected n CW JA ,frIES n PTS Adj.Wtr.Body ('(L' �'(nat)man/unk)
AEC(s): n OEA n IHA ❑UW ❑SPIMA n PWS Closest Maj.Wtr.Body I/
ORW:yes/no PNAo
Type of Project/Activity /0-/-/ 3 47-1 l3, 6, 4 4p,- ,l //
(Scale 1 -f-s )
Shoreline Length
•
Access Length , - ,r_... _.. _._
Pier(dock)length ? )
14 Fixed Platform(s) i ) r )I',
Floating Platform(s)
i
4
Finger pier(s) III 1111 ! i ►
lillil 11E1
4...
Total Platform area 11111
Groin length/# ■
Bulkhead/Riprap length ,. —_ iler4121111nlagliA11111111
Avg distance offshore --I ' I i.... .-_-_-- kpUURUUURIIUIIl! UU!' s _1.--
Breakwater/Sill t1'�
illy ail '�
Max distance/length •f jf!( ; I
Basin,channel
Cubic yards i kg II n . 'r j . e
Boat ramp I
• I
1 \li
4In
I
Boathouse/Boatlift
Beach Bulldozing j
f {
Other { v.
_......_._._ __..... , - __ Lam!._.... t. _.__.....,-- _ L
1..._
•
SAV observed: yes no�
Moratorium: n/a yes no)
Site Photos: yes no I {
Riparian Waiver Attached: yes no I . . I
A building permit/zoning permit may be required by: /( (e
Permit Conditions he/a9m U-r �>/l/ /U6 -PX CC'd 1: /,'7 --,i,, n TAR/PAM/NEUSE/BUFFER(circle one)
aGx,/p, A/t/itlt ko ha(L ,i // (1/s,//r /77 IAeS/o/kg/44i n See note on back regarding River Basin rules
,O,'e Pubi'c is'- ilita-itctc.
111 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 OJfi er's PRINTED Name__�� •
/',U/
Signature**Please read compliance statement on back of permit** Signature /f`/
- u7It5 f zoZ3 10i : ' 1ZG23
Application Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
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:
Tar - Pamlico River Basin Buffer Rules 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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

, 4 "Po
til CAMA n DREDGE & FILL N9 91203 A B ') D
Previous permit
GENERAL PERMIT —.
Date previous permit issued
n New I I Modification n 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:
I5A NCAC ❑Rules attached. I. 1 General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name _ Authorized Agent
Address `` Project Location(County):
City / State r'_: L. ZIP Street Address/State Road/Lot#(s) ._--
Phone#( ,) /_/
Email •' -
Subdivision
City ZIP
Affected CW 1. -1 EW {PTA 4"1 ES n PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): n OEA n IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body •
ORW:yes/no PNA:yes/no
Type of Project/Activity /01-/
(Scale c s )
Shoreline Length -----��"-""
Access Length ■- L-_ -- r
Pier(dock)length — 111"111 11111111111 II
i
_Milli
Fixed Platform(s)
Floating Platform(s)
I
� It. .I1IiIIIill
Total Platform area j
Groin length/#
Bulkhead/Riprap length — t. iIIIIIi :.I , .t
11.0.....
Avg distance offshore *
1
Breakwater/Sill , I .I
/.�'Max1
distance/length
Basin,channel 1
Cubic yards - ; g �ttr I.-._
EE ±lft
i
Other
II II I
li
SAV observed: yes no
Moratorium: n/a yes il-R Ilibilli 11 Iiii I -- III
Site Photos: yes no ,
Riparian Waiver Attached: yes no , i
A building permit/zoning permit may be required by:
Permit Conditions / n TAR/PAM/NEUSE/BUFFER(circle one)
'/a ,7 ❑ See 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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
/`r ; [
Signature"Please read compliance statement on back of permit** Signature !
(f . '(� '` .71 • I L' / 10; ? 1 ,`
Application Fee(s) Check tl/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
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:
Tar - Pamlico River Basin Buffer Rules 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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret,Craven—south of the Neuse River, Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext. Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
(Serves: Bertie, Camden,Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

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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 owneror their agent)
Name of Property Owner: / /1210�"g 7 S/n/ 71 Gj
Address of Property: /c.o 3/4 117/1/1,,/0/p C. f (e1
Mailing Address of Owner:y .Sl�'11t
Owner's email: /ems °3� Owner's•P one# 3��-3T 3 sa2
Agent's Name: Agent Phone#:
Agent's Email:
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.
011/ 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(252) 808-2808. 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
Signature of Adj cent 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:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: waiver is valid for up to one year from ARPO's Signature"
Revised May 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 co- '
completed by owner or their agent)
Name of Property Owner: 4b / ,_521,// 4
Address of Property: /G l/ P/t . !7//ClI /if0C,e /,J
Mailing Address oof""Owner: .5iA G-
Ale X
Owner's email:�di6rr tI&l.�/Q03,-CA/9/Owner's's Phone#: .7o1-3: 3-5�7$4-
Agent's Name: Agent Phone#
Agent's Email:
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.
(3P... 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(252) 808-2808. 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'setb.dp111P410.
.
Signature • 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:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a LAMA minor development jai mit.
The Local Permit Officer will help you,if requested. r-:41
BICAPPLICATION FOR n
PHYSICAL DIMENSIONS .›�I
Label roads CAMA MINOR °
z
Label highways right-of-ways
Label local andtaack lines DEVELOPMENT
Label any all structures and driveways currently existing on property
_ nt
Label adjacent waterhody EOQRON ENM AL QUALI Y
PHYSICAL CHARACTERISTICS PERMIT
Draw and label normal high water line(contact LPO for assistance) In 1974,the North Carolina General Assembly passed the Coastal Area Management Act
Draw location of on-site wastewater system
(LAMA)and set the stage for guiding development in fragile and productive areas that
If you will be working in the ocean hazard area: border the state's sounds and oceanfront.Along with requiring special care by those who
_Draw and label dune ridges(include spot elevations) build and develop,the General Assembly directed the Coastal Resources Commission
Draw and label toe of dunes (CRC)to implement clear regulations that minimize the burden on the applicant.
Identify and locate first line of stable vegetation(contact LPO for assistance)
Draw and label erosion setback line(contact LPO for assistance) This application for a minor development permit under CAMA is part of the
Draw and label topographical features(optional) Commission's effort to meet the spirit and intent of the General Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
If you will be working in a coastal shoreline area: the applicant.Please go over this folder with the Local Permit Officer(LPO)for the
Show the roof overhang as a dotted line around the structure locality in which you plan to build to be certain that you understand what information he m
Draw and label landward limit of AEC or she needs before you apply. n9
Draw and label all wetland lines(contact LPO for assistance)
Draw and label the 30-foot buffer line Under CAMA regulations,the minor permit is to be issued within 25 days once a
DEVELOPMENT PLANS complete application is in hand.Often less time is needed if the project Is simple.The
process generally takes about 18 days.You can speed the approval process by making
Draw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
Draw and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
_Note size of piling and depth to be placed in ground
_Draw and label all areas to be paved or graveled Other permits are sometimes required for development in the coastal area.While these
Show all areas to be disturbed are not CAMA-related,we urge you to check with the Local Permit Officer to determine
Show landscaping which of these you may need.A list Ls included on page two of thLs folder.
NOTE TO APPLICANT
We appreciate your cooperation with the North Carolina Coastal Management Program
Have you: and your willingness to build in a way that protects the resources of our beautiful and
• completed all blanks and/or indicated if not applicable? productive coast.
• notified and listed adjacent property owners?
• included your site drawing? Coastal Resources Commission
• signed and dated the application? Division of Coastal Management
• enclosed the$100.00 fee?
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner) - m
FOR STAFF USE n r N
Site Notice Posted Final Inspection Fee Received 51
rrt (y�.."
Site Inspections n v
❑O�
x zC)
Date of Action:Issued Exempted Denied Appeal Deadline(20 days from permit action) DCM Fonn EB1952-2Ol5AteviseA

.ocality Permit Number 52 — _3 OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary waste
)cean Hazard Estuarine Shoreline ORW Shoreline ' Public Trust Shoreline Other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
3ENERAL INFORMATION
STATEMENT OF OWNERSHIP:
LAND OWNER-MAILING ADDRESS I,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
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/O� n� J C m' L person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
f t[ /! �. �� listed as landowner on this application has a significant interest in the real property described therein.This interest can be
4ddress 16 6 13/4 //4MH o eK P del,/LA, /� described as:(check one) Q,p �j
:ity5 CIS State I'tIC Zip ZBTo^Yhone 3 0/'-3 '1 3 _ a ken owner or record title,Title is vested in name o /d bMe / 6�I
�0 Ile G t� 903 ^ C f4474 J. bar— see Deed Book ,�s2 page a in the 3ze2 LJ County Registry of Deeds.'
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tUTHORIZED AGENT an owner by virtue of inheritance.Applicant is an heir to the estate of /Jl/Q'
probate was in County.
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_if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
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NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
7-iry State Zip Phone I furthermore certifythat the followingpersons are owners of properties adjoiningthis property.I affirm that I have given
P Pr P P P h•
mail ACTUAL NOTICE to each of them concerning my intent to develop this property and to applypl for/ a CAMA permit.
(Name) (Address) / /` �y 3/0#11340/
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.) (1) �r�A�!Lp �� ��� �/( �H p� t c_fs /
/668l A6.9iy/iloce_ Fr R (2) !� r _ zp U ,
(3) r./ [ 16171,9 +9H6, T
(4) SaelttOil AA" L Sf4°
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) ACKNOWLEDGEMENTS:
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1 M5 To A// /� 40 /6 geed,lid 47Ztl. may be susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabilize-
SIZE OF LOT/PARCEL: square feet I`ti acres lion and floodproofing techniques.
PROPOSED USE:Residential pir (Single-family Multi-family❑) Commercial/Industrial❑ Other ❑ 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
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies related to this permit application. .
'o your property): Q
This the OZ o day of 20 ,,Z3
1) OCEAN HAZARD AECE TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes ValktlL'�
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
1111.14
excluding non-load-bearing attic space) Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
;2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR.BUILT This application includes:general information(this form),a site drawing as described on the back of this application,the
UPON SURFACES:_square feet(includes the area of the foundation of all buildings,driveways,covered decks, ownership statement,the Ocean Hazard AEC Notice where necessary,a check for$100.00 made payable to the locality,and
oncrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) any information as may be provided orally by the applicant.The details of the application as described by these sources are
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State
incorporated without refereuitin any permit which may be issued.Deviation from these details will constitute a violation of
Stormwater Mana amen Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any permit.Any person devee. ,gdh'Ttir;IEC without permit is subject to civil,criminal and administrative action.
YES NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

NC Division of Coastal Management 26517 A B eD
Cashier's Official Receipt
Date: LI II'141 G� 20
U=Received From: 6CX.A 5l-` `
Permit No.: -23 Check No.: TZ tJ
Applicant's Name: 4- o r^T St-A ►c County:NS\
Project Address: ( (0 0 5 wtlMoaK f & Cl.rA, 5f1`PccJ5 Petty
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date: 1
Signature of Field Representative: 1 C. Date: y/��11( 2-J

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NC Division of Coastal Management 216 5 3 A B 1D
Cashier's Official Receipt
Date: (0 I S 20 23
Received From: QAI 3 1 1-7A (SYrl 'CA/l $ \ 60
Permit No.: ° ' 2 02. 7\ 4l 1 Check No.: g 3Z
Applicant's Name: 1?:)U S WI 1 County: On s‘dtie
Project Address: 6210 `-) q \AUY\ ►1 o G. P
v.
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date: 2
Signature of Field Representative: Date: � ' I S / Z ✓