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Applicant Name
Address
City
CAMA AND DR 'DGE AND FILL 3
GENERAL MAY 13
;11 r RR 2 5'91
PERMI�
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC rf/t/ /I6C-
r% Phone Number
Project Lo tion (C unty, State Road, Water Body, etc.)
Type of Project Activity
State
PROJECT DESCRIPTION I SKETCH LC7
It
°ier (dock) length
Groin length
number
Bulkhead length- LL
max. distance offshore?
�� --) (� L
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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CIAKA Sfc, �s p t�,tC�w
Zip 7 715_1
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This permit is subject to compliance with this application, site ` '
drawing and attached general and specific conditions. Any /X\
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.
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.
permit officer's signature
issuing date expiration date
attachments ZIo, /
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee.
Management Program.