27953_SANDERS, REX_20010605

CAMA and DREDGE AND FILL 27953_
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 C� /' % ZaG
Applicant Name Phone Number ��f` 2
Address >i >
City r �' �" State
Project Location (County, State Road, Water Body, etc.)
`� �. 1. �-, ;.:�• �. tz
Type of Project Activity 3 Vg
PROJECT DESCRIPTION SKETCH
Pier (dock) Length " f-
Groin Length fqi—
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
(SCALE:
This permit is subject to compliance with this application, site drawing P d / 4—
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. ! / / /(V "�'
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- ' ; 0/ n r
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 1
been obtained from adjacent riparian landowners certifying that they G% �/d0 /20
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project s� iGG `"j j� �, f!
is consistent with the North Carolina Coastal Management Program. application fee

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ADJACENT RIPARIAN PROPERTY O STATENEENT
I hereby cer dfy that I own property adjac nt to
erne of Property Owner)
property Io":a`i at . _601
�'d+C-
(Lot, R[ k, Road, etc.)
©n �. , in .�! — N.C..
(Vita rhodv) (Town andior Coiruty)
He �as lesckibed to me as shown below, the development heir, proposing at tl}iat location,
and, 1 have ; '.,;F,;ticns to his proposal.
PL SC' I""'TON AIND10R DRAWING OF PROPOS)l ' °N '.11: OP:�ILN-r
(To he fiffed in by individual proposing t'ez '` ov-z �,l
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Signature
Print or Type Name
3 5� " f Z-',- 9 �� 5�0
Telephone Number
Date:
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ADJACENT .RIPARIAN PROPERTY OW--,��. S'TATEN ENT
(1425X
I hereby certify that I own property adjacent to ry , s
ame of Property Owner)
property located at
(Lot, BI k, Load, etc..)
can�
(Wat rhody) (Town and/or Cot.uty)
He has desclYued to rice as shown below, the development t,P is pioposing at that Iocatioa,
and, I havt; ; , ),'f,. ;ons to his proposal.
D'A; "`.:SON k'SD/OR DRAWING OF PROPOS T►'. F YOPNILyf
KTo be filled in by individual proposing
fia 7M S Akk , r;,v XL
1 " '�' -'1 kxr`i'a
Si=nat e
a
Print or Tvpe Name
Te:ephone Nurnber
CDate:
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