25680_OGLESBY, BOBBY_20010302

CAMA and DREDGE AND FILL 25
G L N L K 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
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
Phone Number
Zip
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) Length
Groin Length R
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
v _
.........
Boat ramp dimensions € ?
otherFTI
i
71 1+
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

TOMMY,S DI7RD
�P'TOMMY OGLESBY,063PH 728-6910 COUNMOREHEAD
i Pay to the �
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4397
Date 66-30/531
006
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Boo '.Wort, N.zonsC. 28516
For
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Dollars
GUARUTAN®SAFETYYELLOW, E

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent t 's
(Name of PropertyOwner)
property located at f f (0
(Lot, Block, �oad, etc.)
on in `
N.C.
( aterbody) own and/or Cou y)
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
-4ob:Lu xl CG/csby
Print or Type Name
Asa -%L-36oca
Telephone Number
Date: a f 131,0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent toA's
(Name of roperty ner)
property located at
(Lot, Bloick, Road, etc.)
on , in , N.C.
( aterbody) Town and/or Cou y)
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
Telephone Number
Date: