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CAMA and DREDGE AND FILL ---erg
G E N E R A L o
P ERM TAUG 17 2001I
as authorized by the State of North Carolina STALMANAGEMENT�
Department of Environment and Natural Resourc s a0ctnis es Commission
in an area of environmental concern pursuant to 5 NCAC r
Applicant Name Phone Number
Address `
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity 1 10 4,. } f
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PROJECT DESCRIPTION SKETCH
(SCALE:
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77,
)
Pier (dock) Length
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1[.
Groin Length
number
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Bulkhead LengthA.
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max. distance offshore-�4
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Basin, channel dimensions
cubic yards
1t
Boat ramp dimensions
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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
applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void.
1 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 b signing this permit that 1) this project is consistent with the local
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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
i have no objections to the proposed work.
attachments
i In issuing this permit the State of North Carolina certifies that this project
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is consistent with the North Carolina Coastal Management Program.
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application fee