27589_BURTON, ED_20010307

CAMA and DREDGE AND FILL
G E N E R A L
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
Citv
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length r, F
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
State
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
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applicant's signature
1
permit officer's signature
issuing date expiration date
attachments
application fee

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ORDER OF
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DRAWER: TRAVELERS EXPRESS COMPANY, INC,
P.O. BOX 9476, MINNEAPOLIS, MN 55480
DRAWEE: FIRST INTERSTATE BANK, HELENA, MT
I Cr r DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
AND OTHER TERMS ON THE REVERSE SIDE.
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ;CD 'sgR7'O N ,s
(Name of Property Owner)
property located at 1 /o O OA 9 (- 6,of
(Lot, Block, Road, etc.)
on J&GyA6 SOUTA) , in ?lNC— e1464L StfOR-r-s , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
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Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 16 0 04k164 ,
(Lot, Block, Road, etc.)
on f�Y� 6 [.l 5t� LkPD , in ))) � f o l L. , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Signature
Print or Type Name
0-'s-�) 7" o / '? /
Telephone Number
Date: D

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