13822_WIEDMAN, JOHN_19941007

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CAMA AND DREDGE AND FILL �� -r- _ t . -t
GENERAL �� ����
PERMIT �'
as authorized by the State of North Carolina y
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC f /V
Applicant Name �" '!" f�lr! -�' °� Phone Number
Address - �.� .ff' C� �r� � ti- .•, � T
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City "- State zip s G'
Project Location (County, State Road, Water Body, etc.)
Tyne of Project Activity :; r
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PROJECT
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Basin, channel 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- applicant's signature
come null and void.
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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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
issuing date
attachments
permit officer's signature
expiration date
application fee
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
is property located at
(Name of Property Owner)
(IA Block, R64 etc.)
11
on SI I CiZ c� , in /�!F v ��i ,�/�O�r�. _ , NC
(Wat ) (Town andlor 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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVII,OPMENT:
(To be filled in by individual proposing development)
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I hereby certify that I own property adjacent to
--�Y071,tL) W � F� � � llil i8 J is property located at
(Name of Property Owner)
(Lot, Block, IXoad, etc.)
on v c. O ? rl l( , in /�� c c� Q &1:�,, iy. C C% NC
(Waterbody) (Town andlor 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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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