27236_SMITH, THOMAS_20010515

CAMA and DREDGE AND FILL
D
G E N E R A L
P E R M I T MAY 5 ZOO1
as authorized by the State of North Carolina COAS ALMANAGEMI
Department of Environment and Natural Resource
in an area of environmental concern pursuant to 15 NCAC
Applicant Name Phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
ana auacnea general ana specmc conamons. Hny 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.
Zip
272364
Is Commission
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee