22288_WEINER, JACK_19990611

J ' CAMA AND DREDGE AND FILL
GENERAL N� 22288 "
PERMIT 1 �.
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
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions_
cubic yards
Boat ramp dimensions
Other
SKETCH
JT
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.
State
7,
Zip
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applicant's signature
11! permit officer's signature
issuing date
attachments 0� J_.
application fee `�ZD. dQ
(" fi ,a 6)yt1/
expiration date

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ADJACENT RIPARIAN PROPERTY OWNER STATEMEENT
(FOR A PIERIMOORING PILINGSIBOATLIF (BOATHOUSE)
I hereby certify that I own property adjacent to J/ae& �E=,tJtz-1 's
(Name of Property Owner)
property located at 3'9 L-c e uJ Nu)� "*sE
(Lot, Block, Road, etc.)
on w� 5 RG� , in iZz.� , N. C.
(Waterbody) (Town and/or ounty)
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/boatlift/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)
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ti
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J—ig�n�ature
Print or Type Name
11 �4q — D �;I.3 d
Telephone Number
Date: lc:� ` 7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent io 5Ag,, .-.SE�.1JC� 's
(Name of Property Owner)
property located at 32 L-C e w ktt� "&sE
(Lot, Block, Road, etc.)
on Low w� S RGC , in ME iLRz..'CT Co , N.C.
(Waterbody) (Town and/or ounty)
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/boatliftlboathouse 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)
.s,t>V
ti
S�
fl
Sign tore
Print or Type f4ame
Tel one N ber
Date: