11825_WILLIAM, JOHN_19930428

CAMA AND DREDGE AND FILL
GENERAL t18
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
Address I
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Zip
PROJECT DESCRIPTION SKETCH �/ (SCALE:
Pier (dock) length
r
Groin length
number
Bulkhead length
max. distance offshore
i
Basin, channel dimensions
77
cubic yards
- - -- -��{
Boat ramp dimensions
Other —'�—
#--77 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's signature
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 issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

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SERIAL NUMBER
YEAR, MONTH, DAY
PAY TO POST OFFICE
rl U- S. DOLLq RS AND CENTS
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USED FOR
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ADJACENT RIPARIAN PROPERTY OWNER STATENZNT
I hereby certify that I own property adjacent to
is property located at
(Name of Property Owner)
11
(Lot, Block, Road, etc.)
on z- , in 0L /'f,--/l-oco c:r , 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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�ignature2
It) c // i h r e L' 61 /
Print or Type Name
Wq-,)-`�q-1e�3-
Telephone Number

ACENT RIPARIAN PROPERTY r"',NER STA
(FOR A ITLa'Z' r ) ,) /
I hereby certify that -I own property adjacent to
/�//.# •s property
Name
located at //a q L%vr 2-4-z-
(Lot, Blockon, Road, etc.j.
-in G R�E.vTit � .v � 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. e -
Description and/or drawing of proposed development: (TO BE
�17
FILLED IN BY INDIVIDUAL PROPOSING DEVELC)P1+T)
� t
Signature
-� o L� i✓ �i p D p iitJ/� 12 �7
Name
Phone ?•'umber

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