22378_WALLACE, JAMES_19990707

CAMA AND DREDGE AND FILL
GENERAL N 223#ri
PERMIT
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' Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
i
PROJECT DESCRIPTION SKETCH ^` �, �* j f t w (SCALE: )
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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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,
imprisonment or civil action; and may cause the permit to be-
come 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) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
ap p
i
permit officer's signature
issuing date j expiration date
attachments
application fee

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SERIAL NUMBER YEAR MONTH DAY POST OFFICE "-" ^ - U.S. DOLLARS AND CENTS
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NEGOTIABLE ONLY IN TH U.S. AND POSSESSIONS
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ADJACENT PP'.�'RTY OWNFR STA
EMUEr
(FOR A IT
PaVERED BOAT L rl)
I ;ereby cerufy that I own property &1 acent to -
's
(Name of Property owner)
property located at � �;� v
(Lot, Bloc q Road, etc.)on
in
nterbody) ('Town and/or N.C.
County)
He has described to me, as shown Wow, the development he is proposing at that
location, and, I have no objections to his prcT,%. Al. I understand that a pier/uncovered boat lift
must be set hack a minimum distance of fifteen J!zt (15') frn-m my area of riparian access unless
waived by me.
AQ n91 wish to waive the setbar:k req,.irement.
AQ wish to waive that setback a NU-I-rrienso
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--------------------
DES Oh AND/OR DRAWING t'3F PROPOSED DE � ^
vELe.,P1�vT:
(To be
filled in by individax,jj pmpu.cing development)
-----------------
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Signature
Print or Type Name
Telephone Number
Date:

ADJACENT R,gARLANT PR(- :' `1'Y OWNER STA
TIMENT
(FOR A PI R/IIN ,' MprED BOAT LI
I hereby certify1-
that I own prc�per' y �.. "cmt to , �'JC Is
property located at (Name of Property Owner)
(IAt, Block; Road. etc.) '
on
(Waterbody) . in
(Town and/or County)
He has described to me, as sown be avv, the level
location, and, I have no objectionF �o his p�pc :, AI understand tr�cnt he is proposir5g at that
must be set back a minimum distal.Ice of fin " ' t (15') from my that a pl c/uneOV boat lift
waived by me. area of riparian access ludess
I AEI wiskn Fo waive the setbark requirement.
" � I
dQ wish to waive that s�.iback v.}uirement.
IDESCRIPTION AND/OR DRAWING OF PROPOSED D _....���
(To be filled in by individu rs' proposing `developme PMENI':
ti
AIA
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/0 efX .t d
Telephone Num r
Date: l /��