28565_NC DOT_20010827

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as authorized b«the State ofNorth Carolina
Department ofEnvironment and Natural Resources and the Coaota|Resources c�pnnnnission �
inanarea m{envinmnnnentalconcern puouani0n15NCAC '
Applicant Name N L Phone Number
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Address
city
Project Location (County, State Road, Water Body, etc.) 1-2,z) 5 C, c, -�7.V, �,,U
Type of Project Activity
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PROJECT DESCRIPTION SKETCH
r
_r .5
(SCALE:
A.J 0
Pier (dock) Length
T
Groin Length
number
Bulkhead Length
max. distance offshore
cubic yards
A
Boat ramp dimensions
Other
This permit iosubject 0ocompliance with this application, site drawing
and attached general and specific conditions. Any violation o/these terms
may subject the permittee to a0ne, imprisonment or civil action; and
may cause the permit hnbecome null and void.
This permit must beon the project site and accessible uothe permit of-
ficervvhentheprojec1ioinopectedforcomp|iance.Theapp|icuntcerti-
0esbysigningthispermittha11)thispoojectisconsistentvviththe|oca|
land use plan and all local ordinances, and 2)awritten statement has
been obtained from adjacent riparian landowners certifying that they
have noobjections tuthe proposed work.
In issuing this permit the State ofNorth Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
applicant's signature
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permit officer's signature
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issuing date expiration date
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