8880_DINGESS, DELMAR_19910828

CAMA AND DREDGE AND FILL 8880
GENERAL V
PERMIT PTA`'
as authorized by the State of North Carolina,
Department of Natural Resources and Community Developmen ag the oaTI Resources Commission
in an area of environmental concern pursuant to 15 NCAC /-/ /g O
Applicant Name © Phone Number del 9C)" 119bl6
Address 6 a F QG
City State C Zip
Pr je t Location (Coun State Road, Water Body, etc.)
W
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Type of Project Activity 7>L ti
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.
i
applicant's signature
permit officer's signature
issuing date expiration date
attachments Iy C / r C / / / r 1ae9 " �,,
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee©� O U 3

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR A ..J,W) to c�
I hereby certify that I own property adjacent to
Name
located at
(Lot, Block, fzoad, -etc.
's property
MWO10
j) ��e in t,l'"' �� N . C .
twalffr Body) mown 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 must be set back a minimum
distance 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 development: (TO BE
FILLED IN BY INDMDUAL PROPOSING DEVELOPMENT)
lgnature
s
Name
Phone Number

y
ADJACENT RIPARIAN PROPERTY
WW OWNER STATEN
( FOR A :�-CA1LV— X
I hereby certify that I own property adjacent to
's property
Name
located at l?
on
(Lot, B1oc]V, Road, etc.)
in
( er Body) FTown 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 must be set back a minimum
distance 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 development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
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Signature
}—r^►a ti� � k ►� N A 1-2L! rI
Name
(Cl1011 241
Phone Ntunber