87197A - Smith, Frant and Painter, Natalie

C''TDREDGE & FILL
NY 87197
Previous permit
GEERAL PERMIT N
Date previous permit issued
E6ew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
`J 8 C D
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 01164 . )_ 10 � U 1 14, ` Zi,l O ❑ Rules attached. 'General Permit Rules available at the following link: www.deq nc Rov/CAMArules
Applicant Name 4. M4 st'&A' t )J taAc i P pe1 r-
Address Ap % ui i4f
City klke oem'll Il•.kk;.state 1.1P_ ZIP •2.'7 sJd-!x
Phone # (767) 3 S ^E " S O 1 S
Email n1k.}"C'a�l ,'tr MNSI(��Ok� fL ('Gl1n
Affected ❑CW YE IN PTA RES �PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yesk9>PNA<9no
Type of Project/Activity
Shoreline Length 1e)& r
Access Length
Pier (dock) length
Fixed Platform(s) .5 t X I C2 CJ rr
Floating Platform(s)
Finger piers)
Total Platform area h O U
Groin length/# •"•`"��
Bulkhead Riprap length 3 d;10 J
Avg distance offshore O
Breakwater/Sill
Max distancey-I'Mgth S 1
Basin, channel
Cubic yards _
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing _
Other
Authorized Agent Jt l(t/i1n kill (11,1G i1VeC-ltfrk
Project Location (County): sirs r P.
Street Address/State Road/Lot #(s) 4i q MR An- sA ^0& 4j
Subdivision Sri b51A bk k. 2 y-1 a -
City. 5C2Ji CX Lh a`1e8nfiE,•a ZIP !2,-tt '
Adj. Wtr. Body ragtrt;, (. 'k_ b GY.tugyI 1'F e ('t" IC . (nat/ tar nk)
Closest Maj. Wtr. Body ��jyr; e k C—fGl) AA
t cIT12t7 c lu (Scale: j=,dt6
C'.AgAL. t'o C-LJRC-lJl`rC Cer
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p1 A-tF0P,14
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IxiUll�IhC�c� �I �t
At CLJl. Yh zs. K
SAV observed: yes no [ l CS t M `� "fit d r
Moratorium: n a yes no McGtrl T�• 1, cc v. l"rvt*, ' c> 4y
Site Photos: no I T' N C
Riparian Waiver Attached: Ves no
A building permit/zoning permit may be required by: �a7 W.� a {' 56 trrh FC A 'E> vt'vc�
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,
Lillian Clark
AgentorApplicant PRINTED Name
Signal e'"Please read compliance statement on back of permit""
Application Feels) Check #/Money Order
�� y. (Please Initial)
JA0 Y4 t — ILA l �1 l�
Permit Offic r' NTED Name
Signaturef`�
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Grant Smith & Natalie Painter
Mailing Address: 308 W Helaaa
Kill Devil Hills. NC 27948
Phone Number: 757-354-5013
Email Address: [e-mail]
I certify that I have authorized Jillian Kalis / Shane Clark Construction ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 100 ft. vinyl bulkhead & 5' x 40' dock
at my property located at 98 Duck Woods Dr. Southern Shores, NC 27949 ,
in Dare County.
I furthermore certify that l 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
Natalie Painter
Print or Type Name
Owner
Title
/ 1 /8/2024/
Date
This certification is valid through /_

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: Grant Smith, Natalie Painter
Address of Property: 98 Duck Woods Dr. Southern Shores. NQ 27949
Mailing Address of Owner: 308 W Helga St Kill Devil Hills NQ 27948
Owner's emailnatalie _ simplesideobx.com Owners Phone#: [phone]
Agent's Name: Jillian Kalis Agent Phone#: [phone]
Agent's Email: iillianta�shaneclarkconstruction.com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
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 (Choose only one
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 riorao 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 ofAdjacent Riparian Property Owner
•OR -
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypediPrinted name of ARPO: Donald & Kelly Mggriff
Mailing Address of ARPO: 100 Duck Woods Dr Southern Shores, NQ 27949
ARPO's email C riffs ine.@.amail.Com ARPO's Phone#: Z eZ `1 q( �/ZZ
Date: %i `waiver Is valid for up to one year from ARPO's Signature'
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL_ RETURN RECEIPT REQUESTED ar HAND DELIVE1 Y
(Top portion to be completed by owner or their agent)
Name of Property Owner: Grant Smith Natalie Painter _ ._
Address of Property: 95 Duckylggtjs pr Southern 1�oreS. Nf 279$q
Mailing Address of Owner: 308 W Helga St. Kill Devil Hills NC 27948
Owner's email natalie Simplesideobx.Com Owner's Phone#: [phone]
Agent's Name: Jillian Kalis Agent Phone#: [phone] w
Agent's Email: jillian(Wshaneciarkconstruction com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certifythat I own property adjacentto 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.
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 noury the N.c. urvtsron or coasrar
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 it you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one
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/ail of the 15' setback _
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
W A++}' o TNT=" wALocw.aY 54�Ts i r, W n,7 JruPc%"t}' , .S N ay -'S A k I T'
1�tG (L.L.(Yti uVut3 tf' t 5f1t.- �hC �.-iry(JQ�`��_
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Matthew Fine V
Mailing Address of ARPO: 6327 Thomas Paine Dr Williamsburg. VA 23188
ARPO's email: m4ttf1 ne(ftotmail.com ARPO's Phone#: _
Date: tJ 1 I `j _ y 'waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

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