7851_MODZELEWSKI, DICK_19901115

CAMA AND DREDGE AND FILL n 7851
GENERAL
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 71Y / d C l
Applicant Name �&I'a Phone Number �� %— y
Address �4 e tire- rQ,
City State Zip
Project Location (County, State Road, Wat r Body, etc.) ���%• c2�,� ��'t� ��`
Type of Project Activity Jt_4
PROJECT DESCRIPTION
Pier (dock) length p 'X
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
t/ Lab
SKETCH �A� (SCALE: I
Y' g '
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
issuing date expiration date
/I, / C 7 /i l f d
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 herebyFertify that I own property.adjacent to
D c.<< -F C Gtl S /Cl 's property located at
(Name of Property owner)
.1.r2 �o�,1r.kHI ;
(Lot, Block, Road, etc.)
on IC ,Jai f.3 F4,4 �(9/.��f✓L—, in IJFEW CqKli t FJ/ cJ � 1. N.C.
(Waterbody) (Town and/ r County)
F?e has described to me, as shown below, the development he is
:_opo.ing at that location, and, I have no objections to his
:�oposal. I understand that a pier must be set back a minimum
��z�zance of fifteen feet (151) from my area -of riparian access
uriless ' waived by me.
I do not wish to waive that setback requirement.
✓ I do wish to waive that setback requirement.
DES
(To
ND/OR DRAWING OF PROPOSED D=- LOPMENT:
in by individual proposing development)
Telephone Number .
C
is 1990i��r,r-rr-�+U

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby-gertify that I own property.adjacent to
J1, c D g E4E 4, 's property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
on in , N.C.
(Waterbody) (Town and/or County)
1;e has described to me, as shown below, the development he is
_._oposing at that location, and, I have no objections to his
:::oposal. I understand that a pier must be set back a minimum
aisr.ance of fifteen feet (151) from my area - of riparian access
uriless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWI
(To be filled in by indiv
r•�
A.. A • ''
Nov i IMM
�r
1JULIPU.ar:ll DEVELUPMENT:
proposing development)
S g Lure
Print or Type Name
Telephone Number .

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