13051_DAVIS, ROBERT_19940420

CAMA AND DREDGE AND FILL
GENERAL Z3051
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 15A NCAC
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Applicant Nam �� l' ' Phone Number r b J
Address
City f
Project Location (County, State Road, Water Body, etc.) `
Type of Project Activity
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PROJECT
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
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violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be-
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applicant's signature
come null and void.
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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.
applicant certifies by signing this permit that 1) this pro -
is .consistent with the local land use plan and all local
issuing date expiration date
or finances, 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
3
this project is consistent with the North Carolina Coastal
application's
Management Program.

r
1430
ROBERT L. DAVIS
NCDL 2940033 PH. 728-6169 66-7538/2531
107 INTERCOASTAL DR. I / 1� nj L�
P.O. BOX 969 i _s e
BEAUFORT, NC 28516
PAY TO Tkth: ( i/
(1Kllh:K Uh• I—�N
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el
ry Point Federal Credit Union
i■ 1208 East Main Street
d Y Ha`/elO K. North carwina 28532-2405
�:2531?53B41: 10800768410L11' 1430

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
hereby certify that -I own property adjacent to
Name
located at
L_
3
's property
, on
/� ( Lot, Block, Road, etc.)
(. JP E �(M O-Quit/Ts4
K in eCW4427- _.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 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 BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
k
d�
Signature
�i-ef V wa y s
Name
Phone Number

I her
located at
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
certify that -I own property adjacent to
t , 0 Q.. U Is property
Name
.144 ,
. on
(Lot, Block, Road, etc.)
in �G� l� / `r -e C� c �j� . 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 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 BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
ignature
/v,�-
Name
Phone Number