14516_SINGLETON, TOM_19950321 (2)

CAMA AND DREDGE AND FILL
GENERAL 14516
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources.,Cpmmission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name Phone Number
P
Address r
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State &r
Zip
PROJECT DESCRIPTION
Pier (dock) length
SKETCH
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(SCALE:
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Groin length
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1
number
Bulkhead length
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—1101,
" ax. distance offshore
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—
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Basin, channel dimensions
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cubic yards
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 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's signature
permit officer when the project is inspected for compliance. �.
e a licant certifies b signing this permit that 1 this ro �~
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4� is consistent with the local land use plan and all local issuing date expiration date
1, mantes, and 2) a written statement has been obtained from
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adjacent riparian landowners certifying that.. theme have no(:
objections to the proposed work. attachments
1 P P
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATE MNT
I hereby.certify that I own property adjacent to
Imh n C�[ 's property located at
(Name of. Pro ty. Owner)
17
%r (Lot, Block, Road, etc.)
on ' ... �' C�C S /�t c 1�� Y , in r C,f , N.C.
(WaterbodY) — (Townand/or County)
ment h s t develop
below
He has described to me, as shown , he
r^.rOr.CSii:'3 atthat locatian, and;1 have no objections to, his
proposal.
------- ------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual.proposing development)
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Signature.
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Print or Type Name
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Telephone Number
19931
Date
rr-r?Tnr,7r
O JUN 0 1 1995 jll II
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