7912_BLACHOWICZ, MICHAEL S_19910415

Applicant Name
Address
City
Project Location
t
l
CAMA AND DREDGE AND FILL
GENERAL �-
PERM I T /
9
COP
7912
as authorized by the State of North Carolina, i
Department of Natural Resources and Community Development Coas ISssCommission
in an area of environmental concern pursuant to 15 NCAC t`�
Phone Number
-' State .�� Zip
4�nly, State R. d, Wd r O etc.) 4�:1?% � ='l! Y iCzd L, �i 1 �J i� 'I°�l1i "��J ✓ , V
of Project Activity
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PROJECT DESCRIPT ON
SKETCH
-ir-
Pier (dock) len th
Groin length
r'
number
Bulkhead length
Wax. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
IOther
J Zd11 ''.
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. �j�� .✓�j��f y �,����
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliancb
The applicant certifies by signing this permit that 1) this pro-
is consistent with the local land use plan and all local,
tinances, and 2) a written statement has been obtained from
adjacent riparian 1anaowners certify.ing t at t ey av—en
obWctlonsTo the proposed work "- ""`""� "' attachments
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plicant's signature
permit officer's` signature
A -
issuing" date iration date
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 STATEMENT
(FOR A PIER)
I hereby-gertify that I own property,adjacent to
2'_11JY11�2 Z_ 's property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
o Z �,1�`U3 �� /? in G'k,E•� N. C .
(Waterbody) (Town and/or County)
Fi_ has described to me, as shown below, the development he is
_.:oposing at that location, and.. I have no objections to his
-zoposal. I understand that a pier must be set back a minimum
of fifteen feet (151) from my area - of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
_ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED D=, LOPMENT:
(To be filled in by individual proposing developrent)
� r
Signa e
'J®U
-Print or Type Name
rAP271g9) Telephone Number .

,s
APR 12 1991 M�
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ADJACENT RIPARIAN PROPERTY OWNER STAR
(FOR A PIER)
I herebygertify that I own property.adjacent to
/C�- .l���C'%�0►�`�Z 's property located at'
(Name of Property Owner)
JI
(Lot, Block, Road, etc.)
in _% L,/�i�li�/1/ ,. N.C.
(waterbody) ( own and/or County)
Fi„ has described to me, as shown below, the development he is
-oposing at that location, and, I have no objections to his
-opo_-al. I understand that a pier must be set back a minimum
::.-;Lance of fifteen feet (151) from my area -of riparian access
un1eSS waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that Setback requirement.
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DESCRIPTION ANDlOR DRAWING OF PROPOSED DEVELOPMENT;
(To be filled in by individual proposing development)
EPR
' �.f�. 2 i9gt
signature
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Print or Type Name
Telephone Number •

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