General Permits (942)

I.
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 t
Applicant Name Phone Number j
Address
City
Project Location (County, State Road, Water Body, etc.)
State k'' Zip
Type of Project Activity I�/ Y
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.
This permk 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 pthat 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 ' ' 1 .'-s
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