8975A - J. Smith

❑CAMA ❑ DREDGE & FILL
a GENERAL PERMIT
3
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N4 89750 (�(L
Previous permit
Date previous permit issued
A B C V
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.dea.nc.eoy/CAMAruIes
Applicant Name '
Address
City
Phone#O
Email
State ZIP
Authorized Ager
Project Location (County):
Street Address/State Road/Lot #(s)
City
Affected ❑ CW ❑ EW ❑ PTA ❑gS ❑,PTS Adj. Wtr. Body (nat/man/uhk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PINS 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/q
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 no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by
Permit Conditions
(Scale:,,*,'i'— )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
4
❑ See additional notes/conditions on back
1
S
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" Signature
7479
Applicatioh Fees) Check ft/Money Order Issuing Date Expiration Date

DIVISION OF COASTAL MANAGEMENT
I hereby ce" that 1 own Property adWerd to ,1-G-�,- K1 - . /tom vn .
• tea J,— _.
c
(Name of Property Owner,
(Project Sits: Address, Lot, Bkmk Rohl, aAbc,) —
on Ce'lal in ern 2 /c�I - C' a rtrc i I "r-j-G�e v><y N.C.
(W r) (CKWT*wn andlor County)
AgWs Named NahlingAddress:
AprWs phone
HelShe has described to me as shown below the developmenthe/she is proposing atthet location,
end I have no objections to the proposal.
DESCRIPTION ANp� ul�►wlntI 9F PROPOSED 4FVELOPMENT
klP der'ehq=jpusf'MindesWpumhebworamma
(PrOparly Owner Informaion
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AM"Adder
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-vaad for one aakmdar year after signaWW _ ' -�,�--Z Rammed 00t7

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I hereby that I own property adjacent to _�` c: 1 ' e- / ) . - m , Vk- 's
.v ` -' PmPwtV l
er
ProptyWcamat /0/ 1.iV/6-� e , LA)4-14,�"2 <-r7
(Project SBx Address, Lot, Block, Road, etc.) .
on L i > l in / lu - C t,• : ; F„. l . C ,, yfN.C.
(Waterbody) (Cityrfown and/or County)
Agents Name *
Agents phone #:
MallingAddress:
tte/She has described to me as shown below the development he/she is proposing atthat location,
and I have no objections to the proposal.
DESCRIPTION ANp�p� t1fiAVMM Qf PROPOSED gP4ELOPMENT
Md prop" dsevefopmsl f grust dp In dasplpdon below Pr attach a sifts drawing)
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C-ra ✓�/ �� r4� C _2 72,3j
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'0MV p m A4m*m/&vmHAddrams
DaID
'VaW for one calendar year after slgnakw
4M S.
(Adj cent Prope Owner IllfomWMon)
f of 11 ,�-}-u ct /•�
Pddor 7We Name
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Telephone Nlnnber/Emall Address
q-.15-22
F,ks
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