16482_COOPER, A.B._19960801

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 / "/` • /•
Applicant Name Phone Number -1
Address -
City � l'% �/ State/ Zip
Project Location (County, State Road, Water Body, etc.)
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Type of Project Activity�-
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016482a(--�
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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 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.
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(SCALE:`�� )
applicanyrs signature
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permit officer's signature
issuing date expiration date
attachments 0 .)// //oU
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

OUTER BANKS MARINE CONSTRUCTION
P. O. BOX 1988 PH. 919-240-2525
ATLANTIC BEACH, NC 28512
PAY
TO THE
ORDPR OF.
1
66-112
DATE+ `-' 531
$ S� c>v
DOLLARS Ill
BB&T
N�,Ra AHo,��.T�oM.AHY
�r MOREHEAD CITY, NORTH CAROLINA 26557
FOR ���+`` 6�6��2 -L
II'0000 28 5811' i:0 5 3 10 1 1 2 11: 1 2 3 10 15 29 511
NP

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to 121 . 1i . coz 2-ZZD ,s
(Name of Property Owner)
property located at , , tE�00 V-� 0
(Lot, Block,' IRoad, etc.)
on , in _�a-CI iA ►-�� i , 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 a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
U%
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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TAP
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Signature
Print or Type Name
Telephone Number
X Date: �e —

ADJACENT RIPARIAN PROPERTY OWNER STATFAIENT
(FOR A PIERIUNCOVERED BOAT LIF7)
I hereby certify that I own property adjacent to 9 CccIs
(Name of Property Owner)
property located at
on
(Waterbody)
(Lot, Block, Road, etc.)
in
(Town and/or County)
N.C.
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/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP.�NT:
(To be filled in by individual proposing development)
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---------------------------------------------------
Si ature
Print or Type Name
N m
Telephone Number
Date: — Z — 7�C