13991_SMITH, RON_19950403

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CAMA AND DREDGE AND FILL
GENERAL �p t 3919
PERMIT
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 / /-J / "°
Applicant Name 5e,'3' S 111
Address�7yy4/
City State
7,
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
zip
3 Ll S 1
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PROJECT DESCRIPTION
Pier (dock) length
SKETCH 94p,j'T (SCALE:
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IlkBoat
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Groin length-,.-
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
ramp dimensions
Other71
This permit is subject to compliance with this application, site l
drawing and attached general and specific conditions. Any �% j S"
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.
o permit officer's signature
issuing date expiration date
attachments / r
In issuing this permit the State of North Carolina certifies that %� ".�' I i <
this project is consistent with the North Carolina Coastal application fee
Management Program.

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62499754708 950403 285601 * *50*00
YEAR, MONTH DAY POST 0FFICE -• U. S. DOLLARS AND CENTS
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that -I own property adjacent to
)9LL �yoy EM 1 lL 's property
Name
located at 1� , on
(Lot, Bock, Road, etc.) - l
in 3E N.C.
iz - / ,
(water Body) (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 must be set back a minimum
distance of fifteen feet (15') from my area of riparian access
unless waived by fie.
/- I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVEI.OPI=)
9-�, PA4"v
Sigriat�re
Name
Phone Number

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'td Old... a ShoWn,below the
e has described:
development he CIS
proposing at that.locatign Arid I have no objections to his'
4
proposal., I understatld that a pier must he set back a minimum
of fifteen feet �151) from m Y area
d i S t a nc el ri n of ripa-rian access
unless waived by me
I do not Wish to waime that setback requireme�pt.
I do wish to wa i v L, that sell -back requir6m, e n t
t 7: .1
D.Scription a; proposed: deve lopm ent: (To
i BY INDVIDUAL
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