7920_MOSELY, WILBUR_19910107

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
C_ 7920
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
Address
City
Project Location (County,
N , ,, A - -
Type of Project Activity
Road, Wite( Body, e .)
PROJECT DESCRIPTION I SKETCH
Phone Number
State -11 - zip
(SCALE:
Pier (dock) length .�
Groin length. _. I l (� qJ
� y
number
Bulkhead length
V O
max. distance offshore
Basin, channel dimensions
0 p O
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-
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.
% applicant's signature
permit officer's signature
A Z o
issuing date
n expiration date
'�
attachments ` # / rTQ�
In issuing this permit the State of North Carolina certifies that J�J
this project is consistent with the North Carolina Coastal application fee CC��
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Avg IQ /3019r,41 r�
I hereby certify that I own property adjacent to
rs property located at
(Name of Property Owner)
11
Lot, Block, Road, etc.
on in , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
/3v�97� �F1"
L� X!S �iNG yJa� X
r
Sig at re VJ
nt or Type Name
2q,'7 - :z,- 2 L
Telephone Number