13967_WHITE, WILLORD_19950131

CAMA AND DREDGE AND FILL
GENERAL
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 lam°` *7 'V •
Applicant Name 11 Phone Number w
Add
ress f
City Z/"
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length � TV
Groin length
number
Bulkhead length
f
max. distance offshore -
Basin, channel dimensions i
cubic yards
Boat ramp dimensionsJ.
a
Other
_State_ AV zip 'f7, l
_ f}
(SCALE:
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 -
applicant's signature
come null and void.
dct �
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.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
issuing date
expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
attachments f
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
Management Program.

WILLARD C. WHITE 1715
MARY ELLEN WHITE
7 HILLOCK CT.
H/UNTINGTON, NY 11743 1-1t�280
PAY TO THE ORDER OF /y l SJ 11 / I s �j
DOLLARS
��MICALBAW
350 MAIN STREET, MUNTINGTON. NY 11743
MEMO 6'P,4 13967-C
1:0 28000 1 2 11: 8 9 1-1, 580 l 70 5
0
}
-J

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Mr. & Mrs. Willard White's
(Name of Property Owner)
's property located at
(Lot, Block, Road, etc.)
on ,, r,-PPk , in pamirl,,,nty 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. I understand that this devc1epment must be setback
a minimum distance of 15 feet from my area of riparian access
-----------------------------------------------
unless waived by me. I do not wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
See drawing on reverse side.
Signature
1i}rii
Print or Type Name
Telephone Number

Al <) /--,70 /P
Z,3' 1 tno%,3
/ si►6111 1`�I P
a• Ba�f Al)
C, f?ijO. RAP 4P/Oj"x ZD / 3 �0/2P ��tx
N

I hereby certify that I own property adjacent to
's property located at
(Name of Property Owner)
(Lot, $lock, Road, etc.)
on in JC. t V ��rC /t i :P , N.C.
(Waterbody) (Town and/or County)
The applicant has described to me, as shown below, the development
proposed at the above location. I understand that any construction,
excluding bulkheads, must be set back a minimum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I have no objection to the project as proposed but do not wish to
waive the (15') setback requirement.
I have no objection to the project as proposed and do wish to waive
the (15') setback requirement.
I object to the project as proposed.
----------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELORME\7T:
(To be filled in by individual proposing development)
r 1�
iRJ'P I by 7 e o
'�t'x— tt4ot k�(e(l
Print or Type Name S
Telephone Number

I-
�j
I i �