26534_DIVISION OF PARKS_20010328

CAMA and DREDGE AND FILLGENERAL L w Un
PERM IT ��Y
as authorized by the State of North Carolina
Department of Environment and Natural Resdur�9�i la __es_
in an area of environmental concern pursuan'
Applicant Name Phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
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.
zip
issuing date
?6534
,/7
rces Commission
dppI IIdl.L � Z1Ir.I IQULC
permit officer's signature
expiration date
attachments
application fee