37292_SMITHERMAN JR, JIM_20040219

1 CAMA / i-=i DREDGE &FILL
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GENERAL PERMIT
Previous permit #
[]New F 'Modification El Complete Reissue
❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
Rules attached.
Applicant Name_____
Project Location: County_ ____
Address
Street Address/ State Road/ Lot #(s) _
City _ State — ZIP
Phone # ( ) Fax # O
Subdivision
Authorized Agent
City____ _ ZIP_-____
Affected El CW ❑ EW j PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH [I USA ❑ N/A
AEC(s):
Adj. Wtr. Body-- — (nat /man /unkn}
❑ PWS: ❑ FC:
-
ORW: yes / no PNA yes / no Crit. Hab.
yes / no Closest Maj. Wtr. Body—---___-- -.
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards —____ ---___
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing _
Other
i
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: I ) I
—. See note on back regarding River Basin rules.
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s)
Issuing Date
Check# Local Planning jurisdiction
Expiration Date
Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
El Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-�46-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza If
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

Feb 01 04 11a20a Sandy
252-726-6112 p.1
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ZO? �4►� t>JE Sat_
I hereby certify that I own property adjacent to y8�F�2
�
�M Svyt iTJ��iQ�villrJ Z$ '?S8!
V%V46WS (SGaNO W 4%Zu4A ' s property
located at VIJE;g. h9t-,4^10 20.40 °n
(Eot, Block, Road, etc.)
in N.C.
(Water Body) (Town and/or County) 2-
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(151) from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
>11 I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual proposing development.)
Date
(45,r4U-ATtnr4 OP NEW gOA'f Z�lFT'-SL1P'-5
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Signature ,
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Print Name
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Phone Number

ATLANrg eEAA REDGING, INC.
Pp BOX 3355 PH?1AUSEWAYNCDL
ATLANTIC BEAC 1
8039839
H, NC 28572
Pay to the
Order of Date
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Atlantic Beach.N_C 2B512 Pa,Y
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3 775
66-30/531
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252-726-6112 p.1
Feb 01 04 10:59a Sandb
FEB
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT Zc,? �at►�l�f�� �-
2f3� (2-
I hereby certify that 1 own property adjacent to
1vER.'S 4Sc.a�to t�s'�Q�Zr�A clOsevt Sri(rTq►2MaN,s propexty7S�3o
located at ' rL.,FW— 115LAA10 2,940 on
(Lot, Block, Road, etc.)
(Water Body) (Town and/or County) �SS12-
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by m.e.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement_
Description and/or drawing of proposed development:
rTo be filled in by individual proposing development.)
t d.( Ste{ A, LLATt t7 N G P q EW qc71'T T- 5 [-s P 6LS
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