28180_TAYLOR, JEFFREY S_20010725

CAMA and DREDGE AND FILL 1
G E N E R A L
P E R M I T ��
as authorized by the State of North Carolina 1
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 AllZip
Project Location (County, State Road, Water Body, etc.)
r+tlEty� fl
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Type of Project Activity
PROJECT DESCRIPTION SKETCH ,If
Pier (dock) Length
Groin Length i
number
Bulkhead Length
max. distance offshore
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Basin, channel dimensions
cubic yards'
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Boat ramp dimensions I m
Other
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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

UNITED
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SERIAL NUMBER YEAR MONTH DAY POST OFFICE U.S. DOLLARS AND CENTS
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ADJACENT RIPARLA-N PROPEWFY ON 11 fER S 1 AITME•• `
(FORA PIER1MOORING PILINGSIPOAT LIFTIBOATI10t SSE)
I hereby certify that I own property adjacent to *ame
operty O ner)
property located at 6114a-74-
(Lot, Black, Road, etc.)
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on ��l lflf' �.�!'J'�i�'J �11 rL'rtn -----
(Waterbody) (Town andlor County)
He has desczibed to me, as shown below, the development he is proposing at, that location,
and, I have no objections to his proposal. I underst -nd that a pier/rnoorina
pdingsiboatiiftlboat�ouse must be se. back a minimum distance of fifteen feet (15') from my a:e.1
of riparian access unless waived by me.
v/ I do not wish to wa %e the setback requirement.
141a wish to waive tr.at setback ralquirenment.
DESCRIPTION A.NfD!OR DRAWL�G OF PROPOSED DEVELOP:NiENT:
(To be filled in by individual proporina development)
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Signature
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Te!ephone Number
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ADJACENT RIPARIMN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to (Name +c�
of Property w ner)'
property located at / _ % % - �, �, •�
(Lot, Block, Road, etc.)
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on 1' L , in 1�
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(Waterbody) (Town and/or County)
He has described to me, as shown below, try development he is prop at teat location,
and, I have no objections to his proposal. I understand at a pier/ moor-=4;
pilings/boatlift/boathouse must be se: back a minimum distance of fifteen ii5') from my
of riparian access unless waived by me.''
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I do not wish to wane the setback requirement. °U.W
_ a.. ire
I dQ wish to waive t ..at setback requirement.
DESCRIPTION- A.ND/OR DRAWLNG OF PROPOSED DEVELOP.*v E`T;
(To be filled in by individual proposing development)
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S' atu e
t�DaS e Y
Print or ype Name
(t )7g-1)-9g�8
Telephone Number
16
Date: 7 -lj -0 /

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