10960_General Permit_19921125

Applicant Name
Address. 5-91
City
Project Location
-CAM'A AND DREDGE AND FILL J
GENERAL I" n 9caf
PERMIT Q
iosso
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coas in an I Resources Commission
ar i
ea f o environmental concern pursuant to 15 NCAC
Phone Number
try.
my„State Roadl Wqt�r Body, etc
Type of Project Activity
PROJECT DESCRIPTION
p�
Pier (dock) length o
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
4 cubic yards
Boat ramp dimensions
Other
SKETCH u,
0
T
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 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.
State ILC Zip % g ;7 4 rI
�I 'aJ 3a'
6'
Y_as-9a
issuing date
attachments / // r/7 e- i.;7& / '?e
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee��
Management Program.
signature
N�,,,,,� u,ut,Cr � signature
-;3
expiration date
__J

ADJACENT RIPARIAN PROPERTY OWNER sTATEMENT
_ (FOR A PIER)
I hereby certify that I own property adjacent to
is property located at
(Name of Proper Owner)
zo
(Lot, Block, Road, etc.)
on wF'S i _' C FI.C. in &242 /13 G644uo) ,. N.C.
(Waterbody)• (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 pier must be set back a minimum
distance of fifteen feet (15') from my area- of riparian access
unless waived by me.
✓ I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fired in by inlividual proposing development)
Y_�.(" of AleeL)dl
Print or Type Name
Telephone Number

3 4v
Dr
to
IM
i
t
1 !
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property ,adjacent to
's property 'located at
(Name of Proper owner)
k0 4 LI S,t C %B+
(Lot, Block, Road, etc.) '
on a(L 11J�,t 1 CRTuIL in &ZL) /,� C��D�f�' , N.C.
(Waterbody). (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 pier must be set back a minimum
distance of fifteen feet (151) from my area -of riparian access
unless waived by me.
V I do not wish to waive that setback requirement.
I do wish to waive that setback. requirement.
---------------------------------------------------------
DESCRIPTION A WOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled ir. by individual proposing development)
Print or Type game
703 -75'%-735"�
Telephone Number

�,67 Icy, 9
6 ay, 3yJ-2
NEW 3 y� 'N-Q.
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