11774_TILLER, KENNETH_19930302

. CAMA AND DREDGE AND FILL
GENERAL Ito 9 11 # 14
PERMIT ; o�
as authorized by the State of North Carolina U
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name ` 'r Y ' Phone Number
Address
City State / Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH,
Gam.
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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-
corne 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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
(' \(SCALE:
F
I.
_ram
applicant's signature
permit officer's signature
i
issuing date expiration date
attachments —7�1 /
application fee #

KENNETH TILLER
REBA TILLER NCDL 1346243 0342
RT. 1 BOX 203 249-2475
MERRITT, NC 28556 2-- 192? 66-152/531 11
Poy To The
Order Of
1VTAl-iT rr A liars
WechoRank of North Carolina, H.A.
Rayboro, NC 28515 � J
Memo Y��L //
1:05310IS291: 0788 20654911- 0342

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner) s property located at
(Lot, Block, Road, etc.)
on 4/7l/ L/ 7 �%✓ ,2 . in (�tf?y2 rsc.Gt' �) , N . C .
(Waterbody) (Town and/o 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)
Signature
JIB
Print or Type Name
Telephone Number

0
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
°/T_Is property located at
(Name of Property owner)
(Lot, Block, Road, etc.)
on in , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Print or Type Name
Telephone Number