89051A - Smith, Daniel and Bobbie

❑CAMA ElDREDGE & FILL N9 89051 ;A; B C D
GENERAL PERMIT Previous permit
Date previous permit issued
RE]New [:]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: www.d .nc. ov CAMArules
Applicant Name
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. 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/p
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 -
RiparianWaiverAttached: yes no -_. i..nJ
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:
❑ TARIPAM/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 Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** Signature
Application Feels)
Check tJ/Money Order
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: DAN I E L SA i 7-k
Address of Property: to do? W &i 11Yiga I lg4 A -L), }k �' & *r li lj Rp N. c 11,744
Mailing Address of Owner:
Owner's email: d cmi 6h.2 S 7 ` VANr)g4_Pwnef's Phone#: -1ri 7, bq-.7-Uq4(o'9
Agent's Name: Agent Phone#:
Agent's Email: I-S _ a BV E
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION MAY 0 9 2024
(Bottom portion to be completed by the Adjacent Property Owner) (('' ��//jj (�
I hereby certify that I own property adjacent to the above referenced property. The individual applyin>�ftlSp-E
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 riprao 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 Adjacent Riparian Property Owner
-OR-
1 DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
c / 4 � / r
Typed/Printed name of ARPO: RCtA)41 011041 a^ 0 r / p
Mailing Address ofARPO: (/�i� 7 �A/""IVak 0✓d �� �( ��
ARPO's email: N"'C/V?(3)�ao,d0'DJ ARPO's Phone#: �S2 S95 /ass
Date: 8 �`� "waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY MAY 0 9 2024
(Top portion to be completed by owner or their agent)
'((r� SM1tN ®��� �
Name of PropertyOwner: ,
Address of Property: h e2 2 (,12! (f Y'g t rA - fi D
Mailing Address of Owner:
Owner's email: 6M IYA2j?!J i7✓ &cj _ Owner's Phone#: — 1 7 V 7� �f W
I . CpM
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
1 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.
1 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 Mall.
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/all of the 15' setback
Signature of 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: 70,rbo„ r-r, ,
Mailing Address of ARPO: UU hoe t.G.
1 ' �y� . t, _ a
ARPO's email: ixr,l7rp'�gp`��,�(J�M�iARPO's Phone#: !;2. Sq J! `J Z 7 it
Date: -waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

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