7942_DOUB, JAY_19901219

CAMA AND DREDGE AND FILL 7942
GENERAL _
PERMIT c y- f� cof
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
Applicant Name ��' "'�r Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.) 4'�
r/ � [-7 f ; -
Type of Project Activity
PROJECT DESCRIPTION SKETCH (SCAL )
Pier (dock) length
fl s
t'
Groin length; w
number
Bulkhead length
max. distance offshore
,y
Basin, channel dimensions,
cubic yards
Boat ramp dimensions
1
Other
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.
attachments
applicant's signature
D �
permit officer's signature
L ,' ICI >/
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee '

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
T
—6 1)T
(FOR A R44iiR)
I hereby certify that I own property adjacent to is
property located at 5S O Q F'F-EC);E-E t4 C (( .
(lot, block, road, etc.)
on in E111�'1ZI�C.1� ZSL� N.C.
(water body) (town and/or county)
He has described to me as shown below the development he is proposing
that at that location and I have no objections to his proposal. I
understand that a pier must be set back a minimum distance of 15 feet
from my of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
(circl
Description and/or drawing of proposed development: ( to be filled in
by individual proposing development)
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Signature
C-L `�f 17cU u
Name
rqI�)
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A•gJP&&)
I hereby certify that I own property adjacent to Shy DoCAB is
property located at
(lot, block, road, etc.)
on �6ucUE S;ougD in ")Ej2j .ALb -TSC.E, N.C.
(water body) (town and/or county)
He has described to me as shown below the development he is proposing
that at that location and I have no objections to his proposal. I
understand that a pier must be set back a minimum distance of 15 feet
from my of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
(circle
Description and/or drawing of proposed development:
by individual proposing development)
( to be filled in
ignature
1-O CUC c4- FF-E PERN
Name
(9 (�) V39 3 - C 76
Phone Number