27529_WARD, JAMES M JR_20010219

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CAMA and DREDGE AND FILL 9
G E N E R A L
P E R M 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
State
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.
Phone Number
zip
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
application fee

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PRESCOTT BROTHERS INC
PAY
TO THE
1437
141 TARA TRL
ARAPAHOE, NC 28510 / v 66-3a53t
DATE
i $
ORDER OF
7��� a DOLLARS
FIRST CITIZENS-
p A Aj �I First-0Ilims Bank 6 Trusl C..Wv
j/�fr'u'K ABs—yboro, N.C. 28515
.M'
FOR
(pia?S'�9 n•p0 L41711- ;:053 100300':0047 1 10 254 29i1'

HICKORY MANOR HOUSE 3363425600 P.01
FEB-01-2EtJ1 53:04 Pt-1 JIH. 11 ARD 252 249 0524 P.01
ADJAC�T,,-i' RIPARLi.N, PRopERTY OWNER STATEMENT
(POR A PIEAIM00PING PILINGSIBOATLIFTIBOATAOUSE)
I hereby certify that I own propeny Adjacent to
(Name of Property Uwnes)
plopert}, Iocahed at
(Vat, Black, Roa , etc,) 1 o/f S dap Z,,,Z tr Verde
on Vt! �,: �k ,'i- C� sa ` 1n ., e.J4 /'l�►-ram ,=-•, N,G.
(Waterbody) ('Town an or County)
He has described to me, as shown below,' the developme.'tt he is proposing at that iocaaon,
a, d, i have no objections to his Propesai. I understand that a picrimooring
pilingstboatlitb'boathouz; must be set back a minimum distance of fifteen feet (I5') from my area
of riparian access unless waived by me.
I do not wish tc waive the setback requirement.
1_ I d4 wish to waive that setback requirement.
----------------- ------- -- �.._------ ---
DESCRIPTION ANMiOR DRAWMG OF PROPOSED DEVELOPNIENM
(To he ftYled in by indivi ddal proposing dMolopment)
Signature
cy` -ems—
Print or Type Name
33�--lo
Telephone Number
Date: } t 0 1

(FOR A PIERIMOORING PILINGS/BOA7ZIFT/BOATHOUSE)
I hereby certify that I own property adjacent to � 3 t,9-W e S 114, �� �� J 2 's
(Name of Property Owner) '
property located at
Z.0,4 >-"t
113Z oc
Block, Road, etc.)
-y
4) g S A.,O� 1 .� 4 l�
on ail}��-1e--j-- CAti-, Ain Q,4 '
� /�- �< < � , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlifL'boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I d-4 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP,'Y[N-T:
(To be filled in by individual proposing development)
1r U
I—, /. n,, o1-,) e- 4/., �
o�y
Signature \
A�SaC•
Print or Type Name
%L3�
Telephone Number
Date: 03 Vim, 0 )

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