28097_RAMSEY, WILLIAM AND LLEWELLYN_20010615

1 V
CAMA and DREDGE AND FILL
G E N E R A L'7-{
if �'v�,
Applicant Name
Address
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
Phone Number
City State w` zip z_
Project Location (County, State Road, Water Body, etc.) hi
a ! +cl p4 1.
Type of Project Activity j I
ana attacnea general ana speciTic conanions. Any vioiauon or inese 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.
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
application fee

MUD BUCKET DREDGING, INC.
ATLANTIC BEACH CAUSEWAY NCDL 8039839
PO BOX 3355 PH(252)726-2191
ATLANTIC BEACH, NC 28512
2712
Dateuj
66-301531
133
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_ Dollars
8�
FIRST CITIZENS
BANKFit--j,ardi B.2...Bank&Trust Coany
NN.C. 28512mp
For � . 7�. � � �--------
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GUARDIAN® SAFETY BLUE W DBL
OCMIM. AMrrkan _ __ _

ADJACENT RIPARIAN PROPERTY DINER STATEMENT
I hereby certify that I own grope:,',, adjacent to
2Zco - j4v-53
s property
located at _ ��� �c7��L��% j72''1 on
.(Lot, Block, Road, etc.)
�jbl�d C= �'ovc-lJ/
* Q �r {- 4 /�./�L i n ,� l LL) K/7-/ c `�4 e i4 N.C.
(Water Body) (Town aid/or County) 29371
He has described to me as indicated below the development
he is proposing at that location and : have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that sEtback requirement.
I do wish to waive that setbac-. requirement.
Description and/or drawing of p:-:)'Dosed development:
(To be filled i.-) by individual proposing development.)
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ature
Pr t Name
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Phor e Number
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. ADJACENT PIPARIAN PROPERTY OPNER STATEMENT
I hereby certify that I own properly adjacent to
(LG 's property
located at _ I Nf3 '3oe')L-'w on
(Lot, Block, Road, etc.)
in t L.q h/T/ : `L3s4e !-4 , N . C .
(Water Body) (Town ar d/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum d_stance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wi3h to waive that setback requirement.
V I do wish to waive that setba(:•. requirement.
Description aid/or drawing of proposed development:
(To be filled i.i by individual proposing development.)
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Date
Sig: -iture
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Pri-t. Name
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Phor :e Number
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