12114_VIDAK, HENRY_19940208

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CAMA AND DREDGE AND FILL
GENERAL,
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 �' fC Phone Number 'I / j
Address
City State Zip
Project Location ounty, State Road, Water Body, etc.) C,
Type of Project Activity 7r I C i T
,-/A J C N
C' 0,1,1-, i '/ b i- 4 1 i /l.. n �-P c /A /1) &A ..0 11Q1-1 .10 J S
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead leVh
max. distance offshore
iBasin, �channel mensions
cubic yards
/Vo
Boat ramp dimensions
Other
SKETCH (SCALE:
z
s
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.
IG
i
r r
n applicant's signature
permit officer's signature
issuing date -)(All Q /'expiration ��date
.0vS
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 `

W-.f,j,OLI
Goose
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kDJACENT RIPARIkN PROPERTY OWNER STATEIENT
(FOR A PIER)
AMID SEAWALL
I hereby certify that /I own property adjacent to
es property
Name
located at
04_ , on
(Lot, Block, Road, 'etc/. )
�lel "-- � ��e&,k ,12,1L"ir' dG�n�� ins �iA(�/ S�,D , /, h.c.
(Water,Body) (Towri 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
FI LLID IN BY I NDM DUAL PROPOSING DEVELOF'?UaU)
S ture !/
/V C Z2 e'-2T
Name
Phone Number

ADJACENT RIPA.RIhN PROPERTY OWNER STATEMENT
(MR A PI ER)
AND SEAWALL MAU TIINANCE EXCAVATION
I hereby certify thatt-I own property adjacent to
Name
located at
's property
Ok4- , on
(Lot, Block, Road, /et&. )
L ee->>���r - G0AI inIJ17, OA(�% �rr�S1, ��.Ce c N.C.
(Vater ody) (Towg and/o ounty)
lie 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 aet 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.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FI 1.7. IN BY I NDIVI DUAL FROPOSI NG DEVELOP?U21T)
Sig-m#ire
Name
9 5 _ 5T��s
Phone Number

T; JACENT RIPARIAN PROPERTY Oh'NER STATE):Eh'T
(FOR A PIER)
AM
SEW�TL N�iCE �QtVA�(j[�j
I hereby certify that -I o
wn property adjacent to
Name 's property
located at
(Lot, Block, Road, let on
O"ater Lody)G�� inG �%� �'i% aJ�✓ A
— � S
(Town and/or c�F/' �`t'C'
lie has described to me as shown ounty)below the development h
Proposing at that location and I have no objections t e is
Proposal. I understand that a o his
pier must be bet back a r;,jnin-,um
distance of fifteen feet (15') from my area of ri
unless waived b Parian access
y me.
I
do
not wish to waive
that setback requjreTient.
.�_ I
do
wish to waive that
setback re quirerr,ent.
Description and/or drawing of
FILLED IN BY INDIVIDUAL PROPOSING I)rVE Proposed develop;,�ent:
plr�@�,) (T+O BE
sj. ature
Name
Phone 1;un,ber

HENRY G. VIDAK 12-91 492
HELEN G. VIDAK
RT 5 BOX 697-A 66-301531
TAYLOR DR 1 �j
NEWPORT, NC 2857Q a'
C $
PAY TO THE 5-01 DO
� G 4/fi
ORD--��E--R,, OFOLLARS
FIRST CITIZENS BANK
first -Citizens Bank & Trust Company _ 135
Salter Path, N.C. 28575
+:053 LoO300+: L3 L?3874631ln 0492