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CAMA and DRED D FILL
G E N E A l 2�io857,
PER IT
as authorized by the State of North Carolina
.Department of Environment and Natural Resources and the Coastal R ources Commission
in an area of environmental concern pursuant to 15 NCAC 4 • � 6
Applicant Name
Address
City
Project Location (County, State Road,
Type of Project Activity
W
Body, etc.)
State
Phone Numberon
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Zip�`j'��1
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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.
�plicant's 3t$nature
per n it officer's signature
date e4piration date
attachments
n -7-1 ,
application fee

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property. adjacent to 1 iM - I Il �?� r1-0 's
(Name of Property Owner)
property located at 4- f - ��,2 j� j - 1 1 l�} 4kLg L , � c e
(Lot, Block, Road, etc.)
on Wt,tA 7.,���� , in
't_ot-Ce_SAP,eJ , 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.
DESCRIPTION AND/OR DRAWrgG OF PROPOSED DEVELOPMF—NT
(To be filled in by individual proposing development)
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Print or Type Name
Telephone Number
Date: 6 lr�- / z2 /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1 h,rn - I . I . � ,S
(Name of Property Owner)
Property located at _L— - pr14 - LA -p — l 1
(Lot, Block, Road, etc.)
on iylti�����:. ',Au L , in ( lo+.�����e� , N.C. sa-�
(Waterbody) u (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I ha:e no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMF-NT
(To be filled in by individual proposing development)
n i',,,
• •� ` r / ,
Signatur
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Print
Telephone Number

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DATE: ��- 2 - 6 4,- 965
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$E,gUFoRT, N.C. T=L: 919- Soo-379q

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MONITORING & COMPLETION REPORT ,
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE' S NAME:
--ILW a 0 N Q &-D
LOCATION:
PHONE:
DATE OF INSPECTION
PERMIT # �<�Nq
FIELD REP.
v�
DATE REPORTEDLY COMPLETE: O
I) Do t measured dimensions of the development differ from those indicated in the permit and workplat?
YES NO circle one].
COMMENT:
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle one]
COMMENT:
3) FUTURE MONITORING ORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? YES O circle one].
COMMENT: