10979_General Permit_19930114

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CAMA AND DREDGE AND FILL
GENERAL d
PERMIT 1a979
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7 `/ J 3 ,'
Applicant Name
Address
City, s�P.o
Project Location (County, State Roa , Water
jw
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length��
Groin length.-
i
number
Bulkhead length
max, distance offshore
Basin, ch-annel dimensions
cubic yards
Boat ramp dimensions
Other. ( j
d %
1 1 <
etc.)
State �� C
dV' d x/Cis LL
This permit is subject to com liance with this application, site
drawing and attached gener I 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.
_ Phone Number
Zip
i 370�
applicant's signature
permit officer's signature
-I4-�,-3 �-fj ; ;-,
issuing date expiration date
attachments 4C 14 C 2/ 1 r a 0 U
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 PROPLRTY OWNER STATEMENT
(FOR h PIER)
I hereby certify that I own property adjacent to
AIs property
Name
located at _ ���� /� p,G� /!�, on
(Lot/Block, Road, etc.)
L. 4�l4/7R"- n _ D'/LSG D.l'/ N . C .
(Water Body) (Town and/or County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a prier must be set back a minimum
distance of fifteen feet (151) f:r.om my area of riparian access
unless waived by me.
do not wish to waive that setback requirement.
I do wish to waive that :setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
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Name '
Phone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
( FOR ix PIER)
I hereby certify that I own property adjacent to
Name 7�>
located at c�7 6� d
( ot,
( Water Body)
's property
on
Block, Road, etc.)
in N.C.
(Town and/or County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a Fier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
U` I do not wish to waive t-.at setback requirement.
I do wish to waive that ser_back requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
S gnature
Name
Phone Number

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