87074A - Smith, Brenda and David

#DNew
❑CAMA ElDREDGE & FILL N9 87074 A B C 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 SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: w .deamc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
Affected ❑CW
AEC(s): ❑ OEA
ORW: yes/no
State ZIP
❑EW ❑PTA
❑IHA ❑uW
PNA: yes/no.
Type of Project/ Activity
Chnmlinn lnnoth
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale:
Access Length
Pier (dock) length
Fixed Platform(s)
ME
■■:
■
■■
®
■
.■.mml
■■■®®®
■■p■■
■
■
ME
ME
®.
::
E:::::m::�m::
Floating Platform(s)
::�■.:..:::EMS
Finger pier(s)
Ems
IN
Total Platform area
MINIMS
Groin length/#
®..m.
....m..;;am;
:..m
n.■
MU
.®
:.�
.�:..■
mom::.■.■�
:■■a
■
���®�I��a���sse�aal:a�l�■®
�mm:
.mmmmm:
'yesno
Moratorium: n/a yes no Site Photos:
Riparian Waiver Attached: e
■i■
■■1■:■■m■
®:■■■■
■■■m■■■
■:■'
■■m■■■■■■B■■�■IiQ®■■■■NN■■■■■■■■{■■
■
■■■
:
■
■■■■
■■■■■■
1■■
■
■
�
MIMI
..■I■■
A building permit/zoning permit may be required by: ( f' '-"�� �lYQ c. n i-•i
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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 NamePermit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit` Signature �.
Application Feels) Check q/Money order 9
Issuing Date
Expiration Date

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:
Owner's email:
Agent's Name:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent Property Owner)
Owner's Phone# 1032 Sb'
Agent
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
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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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/ 6 y ,,41� �� y� IS 9� s
Signature of Adjacent Rip fan Property Owna
-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: l a r6ke ]� Ct wu e r
Mailing Address of ARPO: CoM 6 C Kowa -A 7, ( Cd em+r
ARPO's email:
Date:
ARPO's Phone#: ;2W — 221— KySY
*waiver is valid for up to one year from ARPO's Signature*
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:
Owner's email:
Agent's Name:
Agent's Email:
N
Owner's Phone#:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
P*,A , &�-PAt(C I Uc,
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.
Z 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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
Signature of Adj ent 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: 5-Tokkk24 Bttich
,�oq Wtt;tcs to r�"S,
Mailing Address of ARPO: 3�- 11 R oC6 Noeik- Prl
ARPO's email:
ARPO's Phone#: 7_S Z- 3tZ' Ogr,5
Date: "waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

I
4 . N
77 _RctA
t D� A N/YI
-7-ol
.TIrr+
7D2 CNo` .4A 1 .A/`

ol 4�v

Rio
Fya.
s E"�
r 1` ipp"
t
N

s
i
ii
`9Il`--,i
i tir .
i. .de tee
Fi. 1 ryr,.
m
"
.r 3 y
`yyy—•��'+q�s .
�
1
q
y}
1 9�
+A
N, �1
is
•, ;
j
� � ,, � �
.�,
d
1
\ �