13961_BANNISTER, ALVIN_19950124

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4-Afot Inc. �ov f`
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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 15A NCAC-
Applicant Name
Address
Phone Number
City
Project Location (County, State Road, Water Body, etc.)
State
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Zip
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Type of Project Activity
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PROJECT DESCRIPTION
SKETCH
(SCALE:i
)
Pier (dock) length
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Groin length
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number
Bulkhead length
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max. distance offshore
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Basin, channel dimensions
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cubic yards
Boat dimensions
ramp
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Other
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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-
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.
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The applicant certifies by signing this permit that 1) this pro-
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ject is consistent with the local land use plan and all local
issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
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objections to the proposed work.
attachments _"� •
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee _ Q ;, rc', •° f:.' % j f �r
Management Program.

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950124 285601
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I hereby certify that I own property adjacent to
v N T3 is property located at
(Name of Property Owner)
(I,ot, Block, Road, etc-)
on J 136rJ Gchh l�- , in TSe `, fix _ , NC
(Waterbody) (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.
------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
c , •� ��.,� ; f J 's property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
on � � I�o�r�,Q Gch h l� , in IACr I, x S a c G�a,� � � c,, , NC
(Waterbody) (Town andlor 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.
--------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number

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