26503_NC DOT_20010305

0
Applicant Name
Address
City
Your project is subject to the Tar/Pamlic
v�
CAMA and DREDGE AND FILL River Basin Buffer Rules due to its locat
G E N E R A L Within theT ar/P amlico Basin. Please 9r� 69113
contact Deborah Sawyer at (252)46-
P E R M I T 6481
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
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
State
Phone Number
Zip
i --- , (SCALE: )
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 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-
fies by signing this permit that 1) this project 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.
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

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JAMES B. HUNT JR.
GOVERNOR
BILL HOLMAN
SECRETARY
DONNA D. MOFFITT
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF COASTAL MANAGEMENT
WASHINGTON REGIONAL OFFICE
943 WASHINGTON SQUARE MALL, WASHINGTON, NC 27889
PHONE: [phone] FAX: [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST -CONSUMER PAPER
DENR TOLL FREE HOTLINE: [phone]

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NCDENR
JAMES B. HUNT JR.
GOVERNOR
BILL HOLMAN
SECRETARY
DONNA D. MOFFITT
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF COASTAL MANAGEMENT
WASHINGTON REGIONAL OFFICE
943 WASHINGTON SQUARE MALL, WASHINGTON, NC 27889
PHONE: [phone] FAX: [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST -CONSUMER PAPER
DENR TOLL FREE HOTLINE: [phone]

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NCDENR
JAMES B. HUNT JR.
GOVERNOR
BILL HOLMAN
SECRETARY
DONNA D. MOFFITT
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF COASTAL MANAGEMENT
WASHINGTON REGIONAL OFFICE
943 WASHINGTON SQUARE MALL, WASHINGTON, NC 27889
PHONE: [phone] FAX: [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST -CONSUMER PAPER
DENR TOLL FREE HOTLINE: [phone]