28041_BAKER, MACK_20010626

CAMA and DREDGE AND FILL
G E N E R A L
V041-
P I T
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
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
number
Bulkhead Length
max. distance offshore
'
Basin, channel dimensions
cubic yards
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Boat ramp dimensions �l
E
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 ` )
applicant's signature
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 issuing date
expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they 7
have no 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 Management Program.
application fee

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ADJACENT RWALUrk'V lPJE2OPF.1 17V OWNER STAMNIF—\T
(F04Y A PIEAlMOORING PAJNO'S180AT ZIF7' 80A MOUSE)
I hereby certify that I own propcity adjaccnt to _ ' "LAA is
(Nime of P'rop=*y Owner)
property ItC4101 at
(1.4t, lsfock; bead, etc.)
on Iin_ c g4'4- _ , N.C.
t+erbody) (Town And/or Cciuuv)
He has de=rkbcd to me, as shown below, the development he is propoxing ac thac lo=oa,
rand, Z hays no objections to his pmpo5al. I understand that a pi-'muoring
pilings[boaUi#i/bcmthousc must be = bunk a minimum disaince of f4lwcu rcct (15') from my itr=
of riparian ar.cess wdcas waived by me.
G"" I du Tint wish to waive the sctba&rNuirernent.
I sill wish to waive that scl=k requirement.
DFSCRIFTION AND/OR DRAWU iG OF PROPOSk:D I' EVELaKMLI r:
(To be fiU#d in by irrdividual proposing devalupinera)
MAY 3 1 2001
A
Signauzc
Y0-1
1'Nlt+
Print or Typc Name
Telephone Number
Date: �5{ � 0 - d r

ADJACENT RIPARL-'N PROPERTY OWNER STA=N E_NT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to LII I
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on fA n�� , in N.C.
( aterbody) (Town and/or County)
He has described to me, as shLown below, the development he is proposing at ti a_ location,
and, I have no objections to his proposal. I understand that a pitnimooring
pdin gs/boadif /boathouse must be se; back a minimum distance of fifteen feet;.O fN _sn,
i
of riparian access unless waived by me. I�
I do not wish to wa;v1- the setback. requirement. MAY 3 1 2001
COASTAL MAiVAGEME
I dQ wish to waive that setback requirement. MOREHEAD
DESCRIPTION AND/OR DRAWLN, G OF PROPOSED DEVELOP.NfEYT:
(To be filled in by individual proposin4 development)
Signature
Y-:1 h n r" , / /v
Print or Type Name
Telephone Number
Date: T h olo

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L MANAGEMENT
MOREHEAD
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T^is perm;i
may C.ai.t tr` r-r,
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