8004_EDWARDS, DONALD_19910521

O
CAMA AND DREDGE AND FILL8 r,) 0 4
GENERAL
PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources CommTsslon
in an area of environmental concern pursuant to 15 NCAC 1
Applicant Name _ '� Phone Number
Address
City, i State C Zip
Project Location (County, State oad, Water Body, etc.) d \'
r-•
Type of Project Activity
7 ;
PROJECT DESCRIPTION
SKETCH
(SCALE: )
Pier (dock) length j
�i`u
r tom%
V
izei
Groin length
number
Bulkhead length
max. distance offshore 1-i
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 ripariar landowners certifying that they have no
objections to the proposed work.
applicant's signature
i
permit officer's signature
! d
r
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
:j
application fee

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to of/(//�1�%,�1Zs
property located at
(lot, block, road, etc.
on in -
(body of water) (town) '
:forth Carolina in Pamlico County. The proposal has been described to me as shown bel-w;
the development �pibulkhe
/structure, and the proposed location, and I have no
(circle one)
objcctions to the proposal. I understand that if the development is a pier, it must.
'-,e sct back a minimum distance of 15 feet from my area of riparian access unles.:%Naivod
!••y r.,.,. i d /do not wish to waive that setback requirement.
o•irc1e one)
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,:-•scription and/or drawing of proposed development: (to be filled in by individual
-qN- i ng deve l oFxnen t .) I ND I C ATE THE SIZE AND LOCATION OF THE STRUCTURE AND THE
BF-*IS,'EEN hACII PROPERTY LINE AND THE WATER.
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(Original must be retained in the Inspection Department)
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Name (Please Print)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify
that I own property
adjacent to
jyz�zO
Z--P
property located at
IS /`2��C62
<)n V !- �- T1 I � E� i (lot, blin �ir�'C —
(body of water) (town)
.forth Carolina in Pam unty. The proposal has been described to me as shown below;
the development, ier/bulkhead structure, and the proposed location, and I have no
e one)
objccti.ons to the proposal. I understand that if the development is a pier, it must
I---- sit back
� a minimum distance of 15 feet from my area of riparian access unless waived
by mc. 11 d /do not wish to waive that setback requirement.
(circle one)
;1cscription and/or drawing of proposed development: (to be filled in by individual
•!-oposing development.) INDICATE THE SIZE AMID LOCATION OF THE STRUCTURE AND THE
:.[S!'l.�'CE BL'i�; EEN EACH PROPERTY LINE AND THE i�1TER.
Qu�l<heA�
till
Ira
(Original must be retained in the Inspection Department)
igriature
< Name (Please Print)
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