27113_TISON, URSULA AND BENITO_20010302

I
CAMA and DREDGE AND FILL 27113A
G E N E R A L
PERM I T
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
Address
City
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
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
Phone Number
State Zip
(SCALE: )
This permit is subject to compliance with this application, site drawing
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 r
may cause the permit to become null and void.
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-
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

CAMA PERK8|T aoauthorized bythe State ofNorth Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
inanarea ofenvironmental concern pursuant t A
Applicant Name
Phone Number
Address 3-
City State
Project Location (County, Staie Road,,Water Body, etc.)
The proposed project 1nbolocated and constructed aodescribed
1/� ' - ��vkmorh '
'- does not the necessity
your obtaining any other State, Federal, orLocal authorization.
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Any person who proceeds with adevelopment without the con-
sent nfaCAMA official under the mistaken assumption that the
development isexempted, will boinviolation ofthe CAW1Aifthere
isasubsequent determination that apermit was required for the
development.
,.
The applicant certifies by signing thisdini6igm that (1) the ap-
plicant has read and will abide by the condition
Zip
This
66�lalid for9O days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
f
Applicant's signat
CAMA Official's signature
Issuing date
Expinmi66dato
Attachment: 15 North Carolina Administrative Code 7K.0203

SANDBAG REMOVAL NOTICE
TO WHOM IT MAY CONCERN:
-,give permission to
LiM M _ to act as my agent in my behalf in obtaining a CAMA General Permit to
place sandbags as a temporary erosion control structure in front of my property
at 9 (r:29 s pr=NctF 2 s-nze>r-r
1, have read the specifications in 15A NCAC
7 H.1700 and understand that the sand bags may remain in place for up to years
after the date of permit approval. I understand that I will be responsible for removing the
sandbags within 30 days after that period or at any time that they are determined by DCM
staff or its agent to be unnecessary due to relocation or removal of the structure. I will also
be responsible for removing any damaged sandbags during the period they are authorized
to be in place.
I also understand that the removal of the sandbags shall not be required if at the
specified date for removal they are determined by DCM staff to be covered by dunes with
veoetation sufficient to be considered stable and natural.
AUTHORIZED SIGNATURE:
DATE: f 2
OrZ A5 rz u�tz r� n�Y THE CCPST/i,. Tz�s c 1tzllsSl�ni
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