13064_DAVIDSON, ANDY_19940512

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
9
30,1r
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Qoasta3Resources Commission
in an area of environmental concern pursuant to 15A NCAC f / &, .
Applicant Name �Q'i '✓� +�lj? Se Phone Number
Address t C "tl; ') / i fi(.
City /1 4 .,
Project Location (County State Road, Water Body, etc.) `:
Type of Project Activity -e /, A 4 '
State ��' Zip
a� !� 11- . ly 0 •,,, e
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PROJECT DESCRIPTION
Pier (dock) length}} 1- A
SKETCH f�f� (SCALE:
a
�~ -
�/ )
Groin length
number
Bulkhead length
2-11
� - --• - -- ._ 1. - .- �-- � — --1- --
ax. distance offshore
Basin, channel dimensions
cubic yards
Y
Boat ramp dimensions
OtherVI
- ----
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- ----�--V+.
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.
0rn
applicant certifies by signing this permit that 1) this pro -
is consistent with the local land use plan and all local
ances, 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.
permit officer's signature
issuing date expiration date
attachments
application f` �T G /7 0 60 LIB �Y/ 3 - i � k f
/

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JACEN�` IP I
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I herbby ' "rtify tbat'
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-% ow6' property ad j aCpnt '''t ..'
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laoated eat •Q7'•� w
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_ (Lot* *
131oac, .Road, eta. -
in
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Town and'/or
He has described to me as shown below. the 'development he is
proposing at that location and I have no objecti.ons.to his
proposal. X understand- that a pier must be eat back a .61nimum"
distance of .fifteen feet (151) from rcgy area oh riparian aCCASa
unless waived by roe.
.1 do not wish- to waive that setbac}: requirement. i
I do Irish to waive that setback requirement.
Description and/or drawing of proposed development: (To 13K
FILL= IN SX 21TDIVIDUAL PROPOSING bEVEWPMM)
i
5�y��ar.ure
"no pumber
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Date �; '•�d- a
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OLDS TOWNE LAKE,
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M ACENT RIPARIAN PROPERTY `OWNBR'''fiTATEMBi7T ._�a .T
(VOR•,'rA PIRR) -
I hereby certify that •x own property adj acpnt-- to -
I f Q IS property ..I
Name _-
located at d-- ' S'g - - , on -
(Lot, Block, Ubad, eta.)
_•6�cQ�c�� �. iC�= in &15w I-Eek-J EUF...J H.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
r
Proposal., I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: '(To BL
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
s�&
!tCUUt:
6Fd2—
Phone Number
Date
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