14768_SIEBERT, ROBERT_19950719

CAMA AND DREDGE AND FILL 9
GENERAL .. 4 `SIG
PERMIT 13
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 2 11 j .41 1�1
Applicant Name 7 5- h.
Address
City —
Project Location (County, State Road, Water Body, etc.)
_ State
Phone Number
Zip S
Type of Project Activity 7
PROJECT DESCRIPTION
Pier (dock) length`��
SKETCH
y v. �. �p ' _r.,_ _: (SCALE:
4 •
Groin length
number
Bulkhead length
I
I
�
I
max. distance offshore
!s >
Basin, channel dimensions
cubic yards
( T
_rj
Boat ramp dimensions
Other
I
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.
applicant's signature
permit officer's signature
issuing date expiration date
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 , 6 � 1113 41/

ROBERT F. SIEBERT 0 419
ALYCE A. SIEBERT
110 SLEEPY POINT RD 66-1521531
GLOUCESTER, NC 28528
19
r
PAY TO THE
ORDER OF -
DOLLARS
�TACHOVIA
Wachovia Bank of North Carolina N.A.
Beaufort, NC 285
FOR >_62f2��
PC.
1:053LO1,5291: 5465 L203?8u' 0419

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Name of Property Owner
(Lot, Block, Road, etc.)
on Z!J SII>%-�' in �15EW 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 DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
9
Sign4ture
PC
Print or Type Name
(9/v Y3 z- a 3 �
Telephone Number

'31
,V • .
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
�-Z Is property located at
(Name of Property Owner)
Cl (Lot, Block, Road, etc.)
on 4-5 , in �i e N.C.
(Waterbody) (Town and/or CountOF
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:
IMn h,-% f;11Pd ;n by individual proposing development)
I
/,, . k,0bJ P ENC C,
Print or Type Name
�-� — 0 / 0
Telephone Number