11015_General Permit_19930728

CAMA AND DREDGE AND FILL
GENERAL 1 1
PERMIT
P
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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
Phone Number
Zip
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length !
Gro'rn4eRgtlh
number { ! ! !
Bulkhead length
max. distance offshoreVIX
Basin, channel dimensions
CVY
cubic yards.
Boat ramp dimensions
Other
7,
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.
i
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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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
C4LU W LDAlf is property located at
( Name of Property ocrncr )
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( Lot, Block, Road, etc. )
on preeCS�' (2-14AtAin N.C.
(Waterbody) (Town and/or County)
He has described tome, 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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hig
Telephone Number
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ADJACENT RIPARIAN PROPERTY'STATEMENT
I hereby certify that I own property adjacent to
C 44-v l /'f k) &D W9 ' s property located at
(Name of Property Owner)
4oAe - I 1 C--4 0 ,�4y
(Lot, Block, Road, etc.)
-go ti
on i n f+T Sf �-E 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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iature /
Pr:_nt or Type Name
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Telephone Number

• ADJACENT RIPARIAN PROPERTY C:�;N- R STATEMENT
I hereby certify that I own proper,=y adjacent to
�/ GALL Is property located at
(Name of Property Owner)
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(Lot, Block, Roaf,. etc.)
S'ovito
o n in ,<(�/�'/c €.ate H N. C.
(Waterbody) (Tern and/or County)
He has described to one, as shown below, the development he is
proposing at that location, and, I hav:: no objections to his
proposal.
----------------------------------------------------------------------
DESCRIPTION A14D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual p Oposing development)
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S i t u r ate, u
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PrLnt or Type INamd
05�& L!� Ws
Tel.:.phone Number

ADJACENT RIPARIAN PROPERTY CnM STATEMENT
I hereby certify that I own property adjacent to
`s property located at
(Name of Proper C y ocaner )f
(Lot, Block, fE�ad,%etc-)
�ogv� �'ovilo
on QQ�"C' e!-�IL��L— , in*--�and/or
(C �N.C.
(Waterbody) County)
He has.described to rne, as shown below, the development he is
proposing at that location, and, I hav•�L, no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filleci ;_n by individual • -.imposing development)
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Si(�:lature
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Print or Type Name
Telephone Number

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