26790_LOOSE, JESSICA_20011115

CAMA and DREDGE AND FILL
G E N E RA L
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Reso
in an area of environmental concern pursuant
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
ies by signing this permit that 1) this project is consistent with the local
nd 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.
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
R1 26790
Phone Number
zip
rces Commission
r`
issuing date
(SCALE:
applicant's signature
permit officer's signature
expiration date
Attachments
application fee