28867_SAUNDERS, ANN_20011115

1�1
CAMA and DREDGE AND FILL /A'
G E N E R A L 87
/at
PERM I T
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
Applicant Name Phone Number 1
Address
City
Project Location (County, State Road, Water Body, etc.)_
v ('G, 1ri 3 •
_ State Y ` Zip 2 ! o b
Type of Project Activity dt Sy
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
-I
cubic yards
Boat ramp dimensions
Other
i-iNi iT (SCALE: N
This permit is subject to compliance with this application, site drawing"
and attached general and specific conditions. Any violation of these terms
applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
J
n
may cause the permit to become null and void.'
'
This permit must be on the project site and accessible to the permit of-
permit officer's signature
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
issuing date expiration date
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.
attachments
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
application fee

ANN J. SAUNDERS NCDL 2707895
5810 MURRAY RD PH 922-1304 L�l e2"67 4010
WINSTON SALEM NC 27106
331 GOOSE CREEK BLVD PH 393-8941 Date`
NEWPORT, NC 28570 66-30/531
Pay to the 486
Orderof I $ vz��"
Dollars tg
FIRST CITIZIJk&Tr 4BB
1 �/�1�T�I First-aloBank. 2710Company
jru � 1� Wlnston5alom, N.C. 27105
1:0 5 3 100 3001:0048 56066 L 3 Ln' O4 LO
GUARUTAN10 SAFETY BLUE TSBL

r t r r r r eY r rk7j_�+JU
I hereby certify that I own property adjacent to�
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on �� �� \ s in , N.C.
(Waterbody) (TArn and/or Cpunty)
3He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be jWed in by individual proposing development)
Z� ate, '.
Si re
Print or Type Name
q -yY2-1/oo
Telephone Number
Date: l D

ADJACENT RIPARMN PROPERTY OWNER STATEMENT
I hereby certify d w I own property adjacent to U� '�� �� e. w.���:�� � •�
44mm of Property Owner)
Q -'i".
Blod4 Rom, etc-7
onti in N.C.
(Waterbody) (Tovin and/or Cpwity)
He has desmibed to me as 9wwn below, the development he is p, 9 at that location,
and, I have no objections to his propoW.
DFSCRIMON AND/OR DRAWING OF PROPOSED DEVELOpNjyM
(To be filled in by indiv dad proposing depdopm eat)
P
S1
Print or Type Name
Telephone Number
Bake: /o L o