14588_BIERKE, EDNA_19950517

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 15A NCAC
Applicant Name a� y sr
Phone Number
Address
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City fs _ram,., v ,�' � State Zip `9
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
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number
length,
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ME
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max. distance offshore
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Basin, channel dimensions
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yards
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Boat rampdimensions
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it
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.
issuing date
attachments /�,
applicant's signature
permit officer's signature
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee `�' 1

66_112
EDNA H. BJERKE 531 2597
1109 FRONT ST. 728-3355
BEAUFORT, NC 28516
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.+
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B �UFORT. NORTH CAROLI— 26 16 1
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Mi-'l 1G-, ,:+5 1 : -1 EULL_ACRD FI_IF-11=_r,444 '4 TI]:
JACEN T' RTFAR A.,N rRorLR'FY OWNTT✓R ST ATENILN`T
(FOR ,A PIERIMOORING PILIA)GSIBQAI-L rf-,ROAYIl'QLSE)
I h reby ccz-&y that I own property ad;acznt to �/aZeWrw v .'s
(;dame of Property Owner)
roe ny } ted at !_�--! �'f �!L '..&"eI�.
(Lot, Block, Road, etc.) -- ----- !�
on! in
'aterbody) (Tovm rid/or County)
He has desc::ribed to me, as shown below, the development he is proposing, at t iiat
location, lad, I have no objections to his proposal. I understand that a pier/mooring
pilings/bootliftfboathouse must be set back a rriztimum distance of fifteen feat (15') from my area
VI riparian, access unless waived byme.
1,� wish to waive the setback requirement.
I �Lq wish to waive L%at setback rNuiremera,
3CRTP"T ON AND/OR DRANN"G OF PROPOSED UEYELOPMENT:
(To be, led in by indMdual proposing develvpmeru)
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Print or Tlj}:
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Date:

P . 9,12
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