11865_WILLIS, JON & PHILLIPS, JOHN_19930601

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CAMA AND DREDGE AND FILL NTT
GENERAL , i ! 11865
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 v. phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
i1
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
SKETCH
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
State
WHE
Zip
(SCALE: )
J
issuing date
attachments
i'
application fee '
applicant's signature
permit officer's signature
expiration date

4-
Yan Lorraine Wiffs 4-89
1462
a(CDL 3939872
4915 Holly Ln 919-726-6088
28557
/ 66-301531
Morehead City, NC
Pay to the '' ``
60
Order of
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Dollars
FIRST CITIZENS BANK
Guest
First -Citizens Bank & Trust Company 132
Morehead City, N.C. 28557
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 4 (FOR �-RIM)
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I hereby certify that I own property adjacent to T*rN %W 1LU S 's
property located at 49) T tLL`(- J
(lot, block, road, etc.)
on
�OG�V.E �l9UIJD in &?,CJA� 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 pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do / do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
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Signature
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Name
���nS�� 240-• Z981
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A -PIER-)
I hereby certify that I own property adjacent to TM4 t U-L1S 's
property located at J AUL-L\� LN
(lot, block, road, etc.)
on SO iop in 0Pr=VW—AD CAT4 , 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 pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do / do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
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Signature
w*F} i SAOtm
Name
IZ6-4517
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I1.h/ereby certify that I own property adjacent to
�"� Y�t�uS ' ,�oF+►,I £ ,� `PALupr-, 's property located at
(Name of Property%Owner)
I NuLL�q W
Lot, Block, Road, etc.)
onc�0►.► inORF_NC (aI 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)
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Telephone Number

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