24550_CAROLINA TELEPHONE_20000418

CAMA and DREDGE
G E N E
PERM
as authorized by the State o
Department of Environmen
in an area of environmental
t
AND FILL
I T
f North Carolina
and Natural Resources and the Coastal Resources Commission
concern pursuant to 15 NCAC
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
Phone Number
State Zip
(SCALE:
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- 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
r.
In issuing this permit the State of North Carolina certifies that this project -7
is consistent with the North Carolina Coastal Management Program. application fee

CAROLINA TELEPHONE &TELEGRAPH CO.
JACKSONVILLE, NC 28540
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: Carolina T 1 Pphon R T 1 Pgrph
Address of Property: -- NC Department of Transportation Hwy 12
West Bay Channel Bridge (bridge #16)
(Lot or Street ##, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The ind;hdu
a1
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plaza II, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certif feed Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
i do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
Print Name
oZ ,S 1Z
Telephone NGmber With Area Co e