28117_BROWN, DOUGLAS_20010718

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CAMA and DREDGE AND FILL
G E N E RA L
PERM 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
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PROJECT DESCRIPTION SKETCH
Pier (dock) Length
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(SCALE:
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'fir'
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tGroin
Length
numberBulkhead Length
max. distance offshore'
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Basin, channel dimensions
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cubic yards'ko
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Boat ramp dimensions �y
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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
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may cause the permit to become null and void.
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This permit must be on the project site and accessible to the permit of-
permit officer's signature
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
-
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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ARAPAHOE, NC 28510 ss-aoisai% `DATE�f��rr\" `PAY/;
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Ugkk� Zyw(N t L%U Up's-
(Name oof Property Owner)
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property located at SeCk\M I , 9 dS C COuc }
(Lot, Block, Road, etc.)
on FICJ►t4U. & N-N&OMY' , in 13CW Se(A) , N.C.
(Waterbodv) (Town and/or County)
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 wish to waive that setback requirement.
DESCRIPTIO. AND/OR DRAWING OF PROPOSED DEtiELOPN E`-T:
(To be filled in by individual proposing development)
_ Itt4(�\(\C�
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signature
Print or Type Name
2'S�Z. 6 3 7 /,e-5-7
Telephone Number
Date: ,`' f ,A P

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Iv, %mot\ *- UsA ZAI w
(Name Property Owner)
property located at _t&.kyN n Itk W4 I.40S
(Lot, Block, Road, etc.)
0
on 1F0.\4\tkA. , in NWL'C IU , N.C.
(Waterbody) (Town and/or County)
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
pihngs/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.
T
I d wish to waive that setback requirement.
DESCRIPTION AI`D/OR DRAWING OF PROPOSED DEVELOPI TEtiT:
(To be filled in by individual proposing development)
CnOv �h� e.x I SOn % Q'% Mts out oZ Age.
Signature
2- 2
Pnnt or Type Name
h -7 - 2 3
Telephone Number
Date: �'o- (-

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