28055_CALICO JACK'S MARINA_20010607

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CAMA and DREDGE AND FILL (�
G E N E R A L-
J^ 'ram F
f .• ht
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 Phone Number
Address
City State zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
QIIU QLLQL.I ICU 6CI MICA QI IU ZtJGI II II �WI IUIUVI IJ. / �� �r .,.,�u....� �� ., �..�.....,,,.,, , _ 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- 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 ekpiration 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

............ .......
CO
CAPE LOOKOUT FERRY 1822
SERVICE INC.
66-152/531
1698 ISLAND ROAD
P 0 BOX 271
HARKERS ISLAND, NC 28531 DKFE
Wachovia Bank, N.A.
ll-k—l.hwd,NC28531
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NP
FOR
-I:053 10 1 S"291: 5461 001055II- L822

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIFRIMOORING PILINGS%BOA TLIFTIBOA TIIO USE)
I hereby certify that I own property adjacent to
property located at
(Name of P operty Owner)
(Lot, Block, Road, etc.)
on ? 'I- i'`17C-'- in -- /Z / 12 S l ,�-4 A Al D ,NC.
(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/moor-ing
pilings/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.
I Ito wish to waive that setback requirement.
— — — — — — — —
DESCRIPTION AN}/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled illed in by individual proposing development)
2/24w,ryc,--
f-11LA :�, ;
Signa urea
Print Qr 1- e Narre
Telephone Number
Bate: `yam% -1 C

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/AfOORING PILINGS/B0 4 TLIFT/BOA I HO USE)
I hereby certify that I own property adjacent to _
(Name
property located at L, N �
(Lot, Block, Road, etc.)
r�
Owner)
(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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (1511)
from my area of riparian access unless waived by me.
I_ /—
I do not wish to waive the setback requirement.
_ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT _
(To bulled in by individual proposing development)
1a % T /� ( /-/ r , if 4 w i N ' f t I /
S 1-4 ti - /) ,, /-1' tA —
,
's
Signature
Print or Type Name
C,36-, 2J'�1"
Telephone Number
Dace -

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