26957_TOWN OF ORIENTAL_20001010

CAMA and DREDGE AND FILL ,�
G E N E R A L "F95
P E R M I T �� ►�,�����in
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
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore _
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(SCALE:
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Basin, channel dimensions
cubic yards
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Boat ramp dimensions
Other
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This permit is subject to compliance with this application, site drawing
CK
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
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9
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
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
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
application fee

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1349
PRESCOTT BROTHERS INC �� l
141 TARA TRL ;
ARAPAHOE, NC 28510 ` 66-30/531
DATE L i(' ` ,•L/(� co Ci 471
PAY TO THE / "� $
ORDER OF `J
Ci DOLLARS
FIRST CITIZENS 471
BANKFir 1- ilino Bank 8 T-1 Compan
, iyboro,N.C. 28515
LFOR_- -
ii'00 L349110 ':053 L003001:0047 L 254 29ii'
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to , pG` I s ow�J C 's
ame of Property Owner)
property located at
(Lot, `Block, Road, etc.)
on ��CC��� �� +� , in 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. I understand that a pier/mooring
pilings/boadift/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 d-Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
Telephone Number
Date: A- 7oc-) )

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to eo *el l c At5 ��%J ►C 's
(Name of Property Owner)
property located at
Q S S Tl
Block, Road, etc.)
on of'2ACW-e , in 4 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. I understand that a pier/mooring
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 no wish to waive the setback requirement.
I to wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Print or Type Name
Telephone Number
Date: