89811A - Smith, C.

,lotlOAST-4i~~CAMA [1 DREDGE & FILL
1 i GENERAL PERMIT ~~io~?p~r~~ ~ 8
C /
Date previous permit issued -----!l,.....,../ __
[21 New O Modification O Complete Reissue D Partial Reissue
As authorized by the State of North Carol ina , Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC f I r: r O Rules attached . ~ General Permit Rules available at the following link : www.deq.nc.iov/CAMArules
Applicant Name ---=i..:.o-'-""--1-!...''-'-"'-'-=-'-----''-'--'......__,----'--"---'~----
Address _ __.._-=-,....,.__,_...-'--'-~--"---+-=-'---~.._ ______ _
City ...,p'--!...'--'--'-'",-----,µ:.."-'-"--'-"'=---
Email ---.:'.'\...u..C--'1_5..L..Jf'.1'-'-C::::----"c.J'Y''--'--1----=--.=..o...-':....c...~--='----=-<..:....:...=-'---'('--'-, ..=CO=:-.:.....i'Y\c...,..
~EW
O1HA
✓
E']PTA
Ouw
Affected O CW
AEC(s): □ OEA
ORW: yes no PNA : es 0
Shoreline Length
Access Length ( Pier (dock) length
Fixed Platform(s)
\
Floating Platform(s) \
\
Finger pier(s) '
Total Platform area --~1-----
Groin length/# ____ / __ ~_
~ Riprap length _1=00=-.c'----
Avg distance offshore--~---
Breakwater/Sill ___ -+-----
Max distance/ length ---+----
Basin, channel------,,-----
Cubic yards------+-----
Boat ramp _____ ---+---
Boathouse/ Boatlift ______ _
Beach Bulldozing ______ _
Other __________ _
SAV observed :
Moratorium: 1i7a ·
Site Photos : -
yes (§:)
~ no
<_yesJ no
Riparian Waiver Attached : yes r n
E:)es
□sPIMA
0 PTS
0Pws
Authorized Agent -~---=Cl......;:F,~_....._.,c......:.-'--'-''"-"--'--"---'-'-.:....,.;"--....L------
Project Location (County): __ J -')=--1...-==--------------
Street Address/State Road/Lot #(s) -~~-L--'--'C'-------lr1--c::.;,::,,,=----'------'-'=--'-'-'-'-A-"-
Subdivision~........_-'-'---''---~-"'-'--"----'---'--'------------
City ~ ~ :f
an/unk)
(Scale: 11
'-;..-
A building permit/zoning permit may be requ ired by : _ ___....-'-'--"-'----__,._---'-'-"-'--'---'--+-------
Permit Conditions -------------------------------,---
□ TAR/PAM/NEUSE/BUFFER (circle one)
D See note on back regarding River Basin rules
r D See additional notes/conditions on back
Signature **-Pleas ~ read com'pliance statement on back of permit** I? ,7 ~ 7.,
Appl ication Fee(s) Check #/Money Order Expiration Date
AGENT AUJHORIZA TION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C..n'(\~ S~fu
Mailing Address: 4~0_L\..:_\=----.::CX~~.:::::~~K~~~J:!,._ _______ _
\I\~~ -\+aA.AJ \< NL 7..'1~49
Phone Number :
Email Address:
I certify that I have authorized ~€> ~U-A\:(.,~ <:,
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' o ~ Q\A.,\ ~ ea, J .
at my property located at L\ol..l \ cx~-e...~ t<d I ~(1.(¼ <\'s t'O\()f-
in D O.Xi, 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 Offrcer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
ct.Jg~ -Signature
LX'~6.\t)~ csV"'--'·-\-Vl
Print or Type Name
OW!'~
Title
7 , \B ,n
Date
This certification is valid through _ ___,l_~I __ _
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N c 0tVISION OI' COASTAL MANAGlll8HT .IUAN Pf'OPERTY OWNIR NOTIFICAnoHMAIVEII FORM "~~~=,,, . 8flVBN RECEIPT REQUE$IEP or tWf) DELIVERY
(Top pOftiOII to be complaled by owner or their agent)
Name°' PrcpellV ow,ier. ~:s.-\qt,ec Srnl+n
AddttiSofPtQPllltY; L\OY\ CX'-.t."-Q.d ~,\\"~ W\,o\:
MallingAddtllSSotOwner.-__________________ _
... _..-()Mlef'aPnonel; ~5'l.• l~"')-tAL.\'P o.,,ner.en-. --------
Agent'&Name.la'ocdoO M,::½cN.\ I AgentPhone#~ Wir 8\p~J
Agent's Email: b(o.,ni,Sy~~ <\'Ma_;' . Cc~ ~ ("') ~ to,, y
ADMCllff RIPMIM PflOPIUl'n' owtml'9 CM'IW'ICA1'laM
T i n ::erMM M •,_..,..Ip• St . n& Plip ■■dr Qwar)
llletellf ~hi IOMI propert,adjacenllOttle lbove""8fec1Cld p,operlr. The lndiYldult~ forttlll
permit,-. dllolbed to me, • ltllNn on ttMt lbehed drNlng. O. ~they•• proposing. ~
~,, ..... wlh dlrrJDQljQQI. QMtbe PIP!ddld with 1h11 letlllr. lnt"'CL' ~ _•DO NOT hel'9 ~tothls propoat. __ J 00 have abjec:tlans 10"'65 proposal.
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t undetlllnd that.,, PftlPQM!d pier, d,Oc,k. mooring piarvs. .,.,.,..., llcwkuaar. bollhoule. Iii. or
gruin nlltbellla.:ka.rnkmluftdllllnclor'1S-fmr.p· m,.,. dfipanan aamss unllawaiwld by me
(lhiadocsnat....,lo bulcheads 'arnprap fWllmenls). (If you Wish IO_,. lbe llllback, ,OU p p WO
theappioptlaleblnbelow.)
I 00 wish towahle IOffl8lal of the 15'.--.:k
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Diil: __,~--+4-----=---•--la \fllldfor 11P to OMYNrfAlffl ARPO'a 81QftMura•
RevJsed July 2021
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OocuSlgn Envelope 10 : 620188ES-3091"'471 &-9 EEB-EOFC20a3A9 19
,~,
N.C . DM810N OF COASTAL IIANAGEIIINT _
ADMC&NT RIPARIAN MOPIIITY OWNER NOTl'ICATIONWNVER ~
CERTFB> M, · BEJURN ffECEIPI BEPYEIJ'EP or HAN> QFWEBY
(Top po,tion to be oomplalld by owner or ttNW agant)
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