Smith, Thomas 77397C

Aso
and
App
Add
City
Phoi
Autl
Affea
AEC
ORV
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) _I V 1
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards— l
Boat ramp
Boathous cadift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes n
Photos; yes n
Waiver Attached: ye no
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A building permit may be required by:
( Note Local Planning Jurisdictio
2
17
Notes/ Special Conditions GL
4gent or
--4 - ��❑ See note on back reg rding River Basin rules.
Permit
r
'�'"Please read comliancestatementon backofpermFeels) Check #

I i:lrrBEtlcE & F|LL
EHLIL PERIVIIT
*-lModificadon --iComplete Reissue
by rhe Sate of f:Iorrh Carolina" Dep*rtment of
hi{i ??3$?AB #D
Previous permit #
Date previaus permit issued
and che Coastal Re*ources
Applicant Name
Address I C
Phone #
Affected
,dEC(s):
in an area lat,t;ta l5A
Proiect Locarion:
Sreet Address/t44t6L 'T f'' rNnr,i{
Road/ Lor
Authorized Agent *^--- -..-- City ZI?
Fc* N {ffi
:,:OEA i .r hFlF i-ilH
fNA yes no
r- rEs
i-"1 UBA
j--l PTS
r..iN/A
,"t*
River BasinPhone# (_. . )
Adi, Wtr
Closest l'4ai. Wtr. Body
Pernrit
(scater4_,rl]- )
,k
f
ofirlt:y6t
Type af Projecd Activity
Pier {dock} length
Fjxed Piat{crrm{s)
Floating Platform{s)
Finger
Groin lengh
number
Buikhead/ Riprap lengrh
avg distance offshore
max disunc* offshore
&a:i;r. channel
rubie yards
Boat rarnp
Beach B*lldozing
Other
Shoreline Length
t3
SAV: fiot sur? yes
felor?torjum: nl* yei
Photos:
Walyer Attnched,
A building permit rnay be reguired byr
( lt{ote Local Planning
Notesl Special Conditions
yesI
tt
\ent or
;igd+,rq s Please
,W !K4-read compliance rtateffient on back of permit *a
"1 ,l.* {-/
6r i-*/rs{-
*17 Lr *"tz
i- l s"u
{^ /^ l^vL'{(
note on back
fft-
River Basin rules.
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/TDREDGE&FILL
NER/AL PERMIT
EModification ECompleteReissue IPartialReissue
As by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area concern pursuant to I 5A NCAC
Applicant Name Project Location: County
Address I OOj
N9 77397
Previous permit #,
AB o D
Date previous permit issued1lBOO- - nRdesattactted.
1'-.r-J.r-1-
City Gr<oru
i614,E-Mail
>& z{ffi((NOEA !HHF trIH
tr PWS:
(/\ )st^t"/1,/Cztp ?Utf
t"Tff*"oI Road/ Lot
Or'^o/
Authorized Agent _
Phone
Affected
AEC(s):
Subd
Phone # (_)
Adj. Wtr. Body
River Basin
ztP
,l-nES
D UBA
tr PTS
NN/A ()
)c
(r4
Closest Mal. Wtr. Body Ort rt
ORW:yes PNA yes no
I -l*t-
+
t/,^
,\
)
It oa vr--z/
o 1.,
See note on back
Cv
River Basin rules.
fhf *.ntt
Type of ProiecV Activity Oc f owrc)2- ot'tl :r/,(scate.rprlf )
Pier (dock) len4h
Fixed Platform(s)
JW H,uFloating Platform(s)l*-+Finger
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Beach Bulldozing
Other
-t
Shoreline Length
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes
yes
yes
e no
A building permit may be required by:
( Note Local Planning
Notes/Special Conditions
ca^
Agent or Applicant Printed Name
# Please read compliance statement on back of permit *x x)
#
Permit
Date
-+
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--]--+-+-]
i_t{:1
Hffi*""t
Statement of Compliance and Consistency
This Permit is sub,ect 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
nulland void.
This Permit must be on the project site and accessible to the permit of{icerwhen the proiect is inspected for compliance. The
applicant cenifies by signing this permit that I ) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this prolect 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, certifythatthis project is consistentwith the North CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Proiect:
E othe.'Tar - PamlicoRiver Basin Buffer Rules
Neuse River Basin BufferRules
lf indicated on front of permit, your proiect 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 Resources. Contact the Division of Water Resources at the Washington Regional Olfice (252-946-6481) or the
Wilmington Regional Office (9 I 0-796-72 I 5) for more information on howto complywith these buffer rules.
Division of Coastal Management Ofiices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ r -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-390t
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washingon 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
910-796-72t5
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hahover,
Onslow - South of New River lnlet-
and Pender Counties)
Revised 71061 l7
http://portal.ncdenr.orglweb/cm/dcm-home
AS.IACEHT
Narne d Proporty Otflner:
AddrEcs of Propertl6 'l- 0r,'tc
(Lot or #. Sbs€t or Road, Clty A County)
Agents Name tt
Agenfe phone *
Malling4661*.:_
I hereby cartify that I own
applytng forthis permtt has
they are propoelng
rllrt ll Drlogpropore{, p u must
,O &,llr o,f rucr{p( of tlrlc noflco,
proporly. ThE lndMdual
notlty the DlvMan of Coaslrl ifeargamsnl
Con&ct lnformatlan br DClil olllces IawNiln
I understand thata der, doclq moorlng
bo eet bsaka mlhlmum dlatanc€ of 1E'
I haw no objectiouc to &k proposal. I have objoctions 1q this propooal.
,.88&4RCOAS?i
WAIVER SEgTIOH
plllngs, boat mmp, brealcwater, boathouse, or lifi muet
frcrn my area of rlparlan access unlass waived by me. (lf
you wtsh walve the seback, you mtr4lnltlal the appropriate blank below.)
I do wieh to waive the 15'sstback requircment.
I do not wlsh to walve the 15'setback requlrement.
Prlnt"or
{Rlparlan 0trmer ln$orma0on)
tlot l{orse,* Lane
n eltingAdri'Bss ---tr
$olgiel' I{t }16 lS
e#y/S[araHlp
.$L- lrlo - ttrt / tti{r,. qt.l2g
Talaphone Number I Enafl Addbsl
Dare
E{rs..\o00rl\
I
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t
Z
to the abovs ruferenced
shovm on ths attachedto me
14ec{.t1
L*,
r:rl*" f zo
fReubdAug.ZA1H)
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWN ONIWAIVER FORM
Name of Property Owner:/ ho,qaf ,fa;
ER NOTIFICATI
4l
Address of Property:IZZ Sdu a c{ fn;n { Dr,'tL
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address;_
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this pe rmit has described to me as shown on the attached
they are proposing.
k I have no objections to this proposal. I have objections to this proposal.
lf you have obJectlons to what is being prcposad, you must notify the Dtvisian af Gaastal Management
(DCM) ln wrltlng wlthtn l0 days ol recelpt of thls natlce. Contact lnformatlon for DCM offIcas is
available at htb:/fwww.nccoastalmanasamenllretlweblcmlstaff.lifti,l,to or by calling 1-8,8,&d,RCOAST.
l\lo response ls consldered flre srmo as no oblectlon lf you have been natlfied by Certifled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15'from my area of riparian access unless waived by me. (lf
you wish to waive the setback, you lqgst inltigl the appropriate blank below.)
(I do wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
ation)
Signature
Mailing AddresS
W*6,s
vaa. snird. @ ytu lrol; fiunlra,r,rt, * n
f eiiphi, on e N u frde r7 Em ail Add re s s
(Riparian Property Owner lnformation)<-J-.-'.
{Vrona5 {^,lL
Print or Type Name
,j, is ;;.{.-" S1,0,,, L*,,[\ot f(.rsrM
sr@\
Maltlns Addtess T
Ra\<.iq!., I{C -a&f6-dW*t*effiit-
Number
tdv*?t
B{na.'
Date
7p
Date
Email
(Revised Au7.2014)
,C0{tn
Print or Type'l,lafile
ASJASg$T
Nam* of ProP*rtY Swnen
Addr*ss of Fr*Per$r
Agants Name #;
Agenfn Phone #:
rsRls
eis & *ol*ntY)
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S;u*
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I her*bY hat I cwn to thc sbove ref*rsnmd Ttra lndividual
spPMng
csrttfy
fcr this
ihey are prtPusinS.
- X. , X heve no obje*ttcus ts tkir pr'sp$snt'tr.h*ve mbjecticn* tu *ti* PlePn*S'
breals*/xisr or ltft must
ares of hy m*, tlf
thw apProPrtate hlanlc bei*w")
f . . I dn not$rich t* w*Iv$ ths tS'sstbask requirerrr*nL
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