26095_BERTHELOT, WADE_20010510

CAMA and DREDGE AND FILL
Your project is subject to e i (1
River Basin Buffer R s e i 1 at J
G E N E R A L within theTar/P asin. ease I-w-
u er
P E R M I T contact Deborah�`2)�0�
6481. IVI 1 u 5lu 4 A
as authorized by the State of North Carolina GE�nEN�
OASTa�L NIANA
Department of Environment and Natural Resources and t e �oastif-, mmission
in an area of environmental concern pursuant to 15 NCA
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
1-4-.,
Type of Project Activity
State
Phone Number
zip
PROJECT DESCRIPTION SKETCH rl t: W (SCALE:
Pier (dock) Length
-- .
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
//
Thic r,Pmm rit is ciihiPrt to rnnliaa `�/! ncwith this annlicati�n. site drawing . �r.(, L
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee