11476_General Permit_19930516

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CAMA AND DREDGE AND FILL
GENERAL
l�
PERMIT a�
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 b,
Address
Citv-
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
_ State
r
Phone Number
Zip_
PROJECT DESCRIPTION
Pier (dock) length
SKETCH
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Groin lengthIr
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P
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
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cubic yardsI
4
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Boat ramp dimensions
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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-
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.
app icant's signature
�j' permit officer's signature
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee/
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I he br certify that -I own property adjacent to
's property
ame
located at /Q��, on
(Lot, Block, Road, a .)
N.C.
( ater 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 fifteen feet (15') from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN By INDIVIDUAL PROPOSING DEVELOPMENT)
Px
reel
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I here certify that -I own property adjacent to
/,-J 41Y fI , n,
N
located at
's property
64
on
(Lot, Block, R'ad, etc.)
in �I e.
_ � , N.C.
(Wafer Body) Mown. 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 wa
ive 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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Sign ure
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Phone Number

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