14494_BURGESS, THERESA_19950601

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CAMA AND DREDGE AND FI
GENERAL 14444 -Ps
JUN 0 7 1M 1
PERMIT U
as authorized by the State of North Carolina 00"00000 �
Department of Environment, Health, and Na urt al Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 3� \F0� .►, -�J0 t &Q
Applicant Name
s
Address %''
City
Project Location (County, State Road, Water Body, etc.)
19
tate '
Phone Number C,tC, ' Y)kL 1A1 ) 4`N
zip a ,, `.-, oy
Type of Project Actiivity
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PROJECT DESCRIPTION
SKETCH
(SCALE: N()t4t: )
Pier (dock) length
► ._._ ,
___
Groin length
number
`
Bulkhead length
max. distance offshore '"
T-11 I
Ll
Basin, channel dimensions
j
€
►
4`+� ' I
cubic yards
-'
Boat ramp dimensions
Other
FT
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
applicant's signature
t permit officer's signature
issuing date expiration date
attachments .'�ix� +
Ih .� ;-b c 4 t
application fee_ 3a C