13956_STALLINGS, JIM_19950112

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
i�
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name '� Phone Number
Address E' A,
%
City State Zip
Project Location (County, State Road, Water Body,etc.) i-- r' u
/I let
Type of Project Activity
PROJECTDESCRIPTION
Pier (dock) length
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yards
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Boat ramp dimensions
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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 be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject 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.
attachments
applicant's signature
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee'

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I hereby certify that I own property adjacent to
's property located at
(Name of Property Own
(Lot, Block, Road, etc.)
on 1"�2�, C2oq,G , in AF,� COU*, - _ , NC
aterbody) (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 DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
I
Telephone Number

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IV

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
T1 W S 0 4 LI property located at
(Name of Property Own
(I.ot, Block, Road, etc.)
on (� Rz, CR I C , in �I/Fw /� , � C�J�� _ , NC
aterb ody) (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 DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
signature -
Print or Type Name
Telephone Number

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