27088_BAILEY, JIM_20001219

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CAMA and DREDGE AND FILL
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTIOI`
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project 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.
Phone Number
zip
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

0
JAMES H. POU BAILEY, JR. 11/93 66-30/ 133 3617
PH 919-726-4048
P.O. BOX 267
ATLANTIC BEACH, NC 28512 Date �a �0,0 d
Pay to the n/�/�j i $
Order of
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FIRSTr CITIZENS-3
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IHH-01-1999 11:51 PROII D1:N MOREHEPiB 919 247 3330 TO 7270074 P.02
ADJACENT RIRA.RIAN PROPERTY OWNER STATE'
(FOR A PLER/M00RING PILINGS/BOAT pFIBOATfIOUSE)
I hereby that T own property adjacent tor 's
II_ �7 Name ofkorer�tyg;�)
propertyy located at J / CG .
(Lot, Block, Road, etc.)
�� x�
on /A-1 L A�T�i i r, Pa C , N.C.
(Waterbody) — (Town and/or County)
i
He has described to me, as shown below, the development he is proposing at tit
loeadon, and, I!. have no objections to his proposal. I understand that a pier/mooring
p?i.r-gs/bbaathouse must be set back a minimum distance of fifteen feet (15') from my area
01 riparian access unless waived by me.
I 40 not wish to waive the setback requirement.
I Lo wish to waive that setback requirement.
DESCR MON AND/OR DRAWING OF PROPOSED DEVEL(3P,' YT:
(To be,lilled in by individual proposing development)
r c e ,4 j jj,� 4, ,L 4 c- Pnlnt�grr Type Name
f7 — 7;2 6,
Telephone Number
Date:
TOTPL P.02

5i r Or1 D _M r CRE-+E, q a�7 33v0 TO
'727007d
ADJACENT R ARLAN PROPERTY OWNER STATEY ENT
(FOR A PI R/MOORIIVG PILINGS/BOA2ZIFT1B0ATH0USE)
T hereby 4ertify that I own property adjacent to
(Name of operty Owner)
Property located at
(loot, Block, Road,
on in v
ater ,, N.C.
CW body) (Town and/or mu dy)
He has described to me, as shown below, the development he is proposing at that
location, and, L have no objections to his proposal. I understand that a pier/mocring
piHngs/boatliftlbaathouse must be set back a minimum distance of fifte`n feet (15') from my area
ai riparian access unless waived by me.
I do ngt wish to waive &.e setbaco requirement.
I do wish to waive that setback req',iirement.
DESCRIPMON AND/OR DRAWING OF PROPOSED DEVELOF.MENT: _--
(To be JWed in by individual proposing development)
\v
Signature Cie
13c�G/2 S ,
Print or Type Name f Ju rNrt
ql 7- 4f z -16 a
Telephone Number
Date: 3— — ( 1
TOTi;L P . 02

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SITE AREA 16,631 sq ft

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