21431_AGENS, JANE_19990602

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CAMA AND DREDGE AND FILL J
GENERAL 021431
PERMIT 11�r
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
State Zip
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be- ! t applicant's signature
come null and void.
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

THE RIGHT WAY
66-85/531 1418
J. T. SMITH
0282027235
CHAROLETT M. SMITH
228 SUNSET DRIVE 252-393-7883
DAIT
SWANSBORO, NC 28584
PAY TO'rHE
ORDER OF ti —1 s
a K� ry i,.vn
DOLLARS Bam��•�
Centura BaT15M1
.1 Cape Carlerel 28584 � �3I
MEMO�- er
1:0 5 3 L00a 501:0 213 20 2 7 II' L L, La

ROP
ADJACENT RIPARIANG PILINGS BOATLIFT/BOATHOUSE) v i
(FOR A PIER/MOORI
I hereby certify that I own property adjacent to J R� L L'I �,J �s
(Name of Property Owner)
property located at V-\0 ��RiERFR�r T 1�Ry '
(Lot, Block, Road, etc.)
RJ�K- m CAP[LART�fzE 1 N.C.
on �� - y ?c Tjs-s�C— (Town and/or County)
(Waterbody)
He has described to me, as shown below, the development he �apier/mooring
proposing
location, and, I have no objections to his proposal. I understand
pilings/boatlifVboathouse must be set back a minimum distance of fifteen feet (15) from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(To be filled in by individual proposing development)
pO
A eo A jn?,t 7 71v
fy ;,
signatoe
Print or Type Name
Usaa 3�r3-B 13q
llorn� (05J�) 5a-3 - 651,q -
Telephone Number
Date: - / c' 91,

STATEMENT
ADJACENT RIPARIAN PROPERTYB ATHOUS�
(FOR A PIERIMOORING PILIN
that I own property adjacent to ��A N c A v c R5 's
I hereby certify P p (Name of Property Owner)
property located at 1r10 \►•(ATCR FRONT �Rzv'E '
(Lot, Block, Road, etc.)
C f�Pc CRRiE(ZEi 1(` A�sr--��_, N.C.
on !\z��E� 3�y P�rTF��� C'E�, (Town and/or County)
(Waterbody)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
RpP-'rbk,vy\wve 1-� q00- �-+ 6k
Signature
Print or Type Name
3J -dun.
Telephone Number
Date:

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