8867_GIBRON, ROBERT_19910718

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina,
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Department of Natural Resources and Community Development and the Coastal Resources Cornission
in an area of environmental concern pursuant to 15 NCAC % h —1 2141 0
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Applicant amePhone Numberjl
Address k
City 5 State C Zip a 3 7
Project Location County, State tRoad, Water Body, etc.)
96 6 EL4,,JS %rL
PROJECT DESCRIPTION SKETCH
°ier (dock) length
yr��3
T__" aas
Groin length
number
Bulkhead length _
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
fy'
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.
(SCALE:
f applicant's signature
permit officer's signature
7_1�_9/ l(7-/�)-J)
issuing date expiration date
attachments / " C C
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee' q- V. e v

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
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I herebycertify that I own
y property adjacent to � cb�� �; G'6� �.�: Is
property located at
(lot, block, road, etc.)
on .�i r�Os� ����<
- in �i?��7`-�,�� 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 area of riparian access unless waived by me.
i�/I do
do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: ( to be filled in
by individual proposing developmennt))'J
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Si nature
/-- a, i�A2�t5 T
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
$bi+T C, i rT
I hereby certify that I own
property /adjacent
to f'y'-"T '/ is
property located at
on
(water body)
(lot, block, road, etc.)
in /' , N . C .
(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 area of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
circle one)
Description and/or drawing of proposed development: ( to be filled in
by individual proposing development)
SC—E fi'1�C}c I� FD WP(-" t' 6
Signature
4- L� �-- L-- �d
Name
7z
Phone Number

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