21625_WELSH, THOMAS_19990319

CAMA AND DREDGE AND FILL ea
GENERAL l. 021.05
PERMIT (" ID61
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
State
Phone Number
Zip
PROJECT DESCRIPTION
SKETCH
(SCALE:
)
Pier (dock) length
Groin length
`tom
,i,i 1lV0c:l) 1c, ._ :a,N i Y r ri;
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
s a
_�OLKI fj. A,")
Boat ramp dimensions`•
Otheror
t
This permit is subject to compliance with this application, site
drawing Any
_
V
and attached general and specific conditions.
•
`V/
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.
—.X_C.'J
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.
�ti. �y
;U/vG0J
The applicant certifies by signing this permit that 1) this pro
j.�ri,�
IG
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
>1 yi i ioo
`
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
) 2K►��Ci
Management Program.

UNITEDSTATES ... 75 800 a
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��P.OST/�LSERVICE® .7I�1I. �IONI�.Y OI�1)LI�'
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U.S. DOLLARS AND CENTS
PAY TO CHECKW RITER yt e I j„ II I
IMPRINT ARE j #i.�, t{ f I,
ADDRE S
FROM
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O.D. NO. OR \1J21
I�S E. FOR
., NEGOTIABLE ONLY -IN TH :-AND-POSSESSIONS
+:00000800 21: 133039 L 9 208 Tim

A TIJAC-F,'�a RIPARIAN PR-DPER117 OWNT,'
cy-'IATENEENT
f hereby certify that I own property :-.djacent to s
"ue Of Property Owner)
propc.-y locateti at
(Lot, BIC(I,
�e
Ii iaterb— in ov2s"-L N. C.
7fY) I no Co
OR 911A.-..
has described to me as shown belo thr
is proposing at that location,
.�XVC no objections to his proposal.
'ESLRIYHON AND/OR DRAW, -Y
`'EJIJ !;EVELOPNMN,-T
(To be filled in by indivi 117'-'111
/ r--IFv 1 E - -`_
X, et-
inna!iir
o. ,
Print o.- 15e Name
Telephoi
Date:

ADJACENT P,YeA N PROPERTY OWNER STATE M T
I hereby certify that I own property adjacent to �s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on in
(Waterbody) _ �/ 1 � N.C.
PCCA-4��and/or G�urry)
F1 e has deSLI abed to me as shown bellow, the development he is prop)sing at that location,
and, I have r.+r 0"0ject;.ons to his proposal.
D.t S ; `r.e P ION AND/OR DRAWIN J OF PROPOSED ' ; `; �:.;; ,0p,'1 'V T
(Tb be filled in Icy tndividral proposing deve,lop,�z�p �)
ryl
iYl�t
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Signature
(,S(Clx 4 l
Print or Type Name
3-7 ':S 7
'14lephone Number
Date: