7940_MOULTON, GUY_19901018

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Applicant Name —
Address
City
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
7440
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
State
Phone Number
Project Location (County, State Road, Water Body, etc..)
Type of Project Activity % s,
Zip
PROJECT DESCRIPTION
SKETCH — Ll fvlo,c.
(SCALE:
i , c 1
Pier (dock) length
�
/PE
Groin length:
number
Bulkhead length
r> '
max. distance offshore
Basin, channel dimensions
cubic yards
if
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.
1
applicant's signature
permit officer's signature
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 application fee
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby-pertify that I own property.adjacent to
u 4 0y 's property located at
( ame of Property Owner)
9.2
' (Lot, Block, Road, etc.)
on 13U �414 / , in �l-u� ,(TErzl� C,P�vr�� , . N. C .
(Waterbody) (Town and/or County)
Fie has described to me, as shown below, the development he is
Apo ing at that location, and, I have no objections to his
_,cposal. I understand that a pier must be set back a minimum
al -stance of fifteen feet (15' ) 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.
(To be filled in
OF PROPOSED DEVELOPMENT:
.al proposing development)
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Print or Typd Name
Telephone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby-pertify that I own property.adjacent to
�?-Y i�OU� �% 's property located at
(Name of Property Owner)
(-)TL7 Q H )4w4 Ege"t, Po ,hJ R d . ;
(Lot, Block, Road, etc.)
on fZO6a in Nkry 13 91.1. C_IZBa,1) r. N.C.
(Waterbody) (Town and/or County)
has described to me, as shown below, the development he is
_- opo.ing at that location, and, I have no objections to his
_.zoposal. I understand that a pier must be set back a minimum
a ;_stance 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 DLL LOPMENT:
(To be filled in by individual proposing development)
S'g atu e
Print or Type Name
Telephone Number

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