8871_LYNCH, W GRANT_19910812

Applicant Name
Address � W
City . (ti
CAMA AND DREDGE AND FILL
GENERAL
c C, 8871
/P
PERMIT
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 ZAt
Qo 79a - a21 7
'7 Phone Numbel-7/9— 76s- 3357
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e tom, P7A
State & (—, x zip 2 &,� y
Projec L/ocation (County State Roa Water Body, etc.) � 410�flV
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Type of Project Activity 7
PROJECT DESCRIPTION j SKETCH
In.. 0 .. t 1
Pier (dock) length
Groin length
number
Bulkhead length.
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Otber
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.
# 64
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applicant's signature
r
permit officer's signature
11-1101-91
issuing date expiration date
attachments f ✓ C / l 0
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee l 01 0 a

DR. W. GRANT LYNCH NCDL 785209
MRS. W. GRANT LYNCH
261 HALCYON AVE. 919-722-2717
2914
66-52/531
2 WINSTON-SALEM, NC 27104
a Pay to the N $ S- v ?
a Order of
s ud Dollars
NCNB National Bank
yC of North Carolina Deluxe Banking Customer
Winston-Salem, NC 27101
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i:053LOOS 201: 1933 2 2 2 29112 2914

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _Lv, LyNc-u .s
property located at /:3 7 ; on (SAc-k
—(Ioblock, road, e c. (water
SUJerI) in f441-ir- iS-v,Vi Co2fr= ?I'z , N.C. He has
body) own and/or county)
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 cminimum distance of 15 feet from my area of riparian
access unless waived by me. I do not )rish to waive that setback requirement.
(Clirc e)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to iv. I y 'y 's
property located at St Ar/r i,—uCt o l _3 _;� on 6 'tl
—(Jo , oc , road, etc.) (water
j N✓N in f t �^ �'-� Cc�2 t�1.7� . N.C. He has
body) — own and/or county)
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 15 feet from my area of riparian
access unless waived by me. I do/do not wish to waive that setback requirement.
(:Tr-Te one )
Description and/or drawing of proposed development: (to be filled in by
individual proposing development)
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