11832_SPAIN, THOMAS_19930505

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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
Applicant Name Phone Number / �� S 7 t/
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
4 5
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
/ (SCALE: )
f
1
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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.
applicant's signature
permit officer's signature
issuing date
attachments i-
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
li,
application fee �' � 'i 1-

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800
ow
47947419077 930505 285150 5 i;K 00
PAY TO
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AQ�DR _'r
O O Q NO. OR
USED FOR
1:00000$00 21:
4?94?4190??Ila

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
Name of Propert''y Owner
6r) i lu4
(Lot, Block, Road, etc.)
on��,-� ✓� .� in-, N . C .
(Waterbody) Town and/6r 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.
rr{�` DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
V (To be filled in by individual proposing development)
Signature
Print or Type Name
I
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
e
's property located at
(Name of Proper Owner)
Lot, Block, Road, etc.)
on � a .� : � , i n al4ad t- N . C .
(Waterbody) (Town and/oi 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
'T".o„ s
Imo. /-'~"rl- P.0�
C
Signature I
4
l
��rlssL L DEW
Print or Type Name I
CJ j I _ ,-- -,:3-L-- 3 9L/�
Telephone Number

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