13960_COX, TOM_19950124

O
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
I
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 09'dl. lice %
roe
Applicant Name r Phone Number
Address''
CityState
% /(fC _ Zip
Project Location (County, State Road, Water Body, etc.)
4 r .-,+ .::I , ..• - ( r.!`-r c�e ��IF'a.'� r"e f9,r' f"(t,.+' ,,' / /?''r�• '
Type of Project Activity -. , rs/
r)
— ­L _/ '01 y% t"
PROJECT DESCRIPTION
Pier (dock) length
SKETCH
(SCALE:
�� )
,ry
—
VC w
Groin length
a
_ S
oa a
number
Bulkhead length
g,
r
��
'm'°
► _t~
`•
11
I
I
max. distance/offshore
Basin, channel dimensions
�..
ox
d-� —I—
4
I
I o
cubic yardsaJ
Boat ramp dimensions
0
1
Other:
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.
applicant's signature
} permit officer's signature
issuing date expiration date
attachments — 6 � 211. d l o t'
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

IT
(( Nyy ORDER
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61513149047 950120 285601 * *50*00
SERIAL NUMBER YEAR, MONTH, DAV POST OFFICE U. S. DOLLARS �
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ADDR
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
G0--/ is property located at
(Name of Property Owner)
(L,ot, Block, Road, etc.)
on t�. oi4,,! Ciz rz lc , in 1'�R rr h S40p h,,,' Z c 6 _ , 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)
U Jl Print or Type Name
�U
Telephone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Name of Property Owner)
7o i2,
(Lot, Block, Road, etc.)
'ZO Ar
on � k-lrwc, in Z , ;�.�i_� __ ' i 0e1;F _ - 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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Surveyor
St•nl er Stamp
14gist_ralion Number'
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'HE"I_..IMINA11Y PLAT
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