8000_FULCHER, BILL_19910507

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Applicant Name
Address `
City Al
Project Location
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
C-8000
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107-
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 _ Itf- t Doo
I3rr% F,�,I/te- Phone Number 2L7�
e_ r�\ State %UC zip
nty, State Road, Water Body, etc.)__//�}�y
�c. y-ari_ /'a( ,PIe i^TT/
Type of Project Activity '
Ip�Pr
PROJECT DESCRIPTION SKETCH (SCALE: )
1
Pier (dock) length
Groin length Co
number 5 Q l( CL i P'J l�
of (i✓ I f�
Bulkhead length y
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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- C
applicant's signature
come null and void. 1
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This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro /'-:'-7 )l1t7
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
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 certify that I.own property adjacent to
's property
Name
located at j / �/ �� / ;2� on
(Lot, Block, Road, tc.)
(Water Body) (Town and/or County)
N.C.
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
FILLED IN BY INDIVIDUAL PROPOSING]
7 a —iO ►�
Phone Number

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ADJACENT RIPARIAN PROPERTY 01-JNER STATEMENT
(FOR A PIER)
I hereby certify that I
Name
located at
(Lot,
(Water Body)
property adjacent to
's property
2/ G )E
Block, Road, tc.)
in t
Town and/or County)
, on
N.C.
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 PR POSINGDEVELOPMENT)
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Signature
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Name
1 J'�- Z y7--10 z8-
Phone Number

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