13957_DAUGHERTY, BILL_19950120

0
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
I'AM LI <`J �C-,U tJ T �
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area off environmental concern pursuant to 15A NCAC
Applicant Name /'�' �'r".� Phone Number "
Address • �.� �` C,,r: �cr..��.� r'
City ' ' t'J'•'• State NT Zip d,{�
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
- t: A
PROJECT DESCRIPTION
Pier (dock) length��
SKETCH
rx
(SCALE:777-7
)
I
a
Groin length
n
`
number
Bulkhead length
max. distance offshore
(
I
i
•
j
Basin, channel dimensions
I ii+c c� i `�
, —
` ___
i
! T 4 Y-,..-•„.w.---' - _ o , ` _ I
cubic yards
_
Boat ramp dimensions
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 the have no
1 P Y g Y
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
permit officer's signature
issuing date J expiration date
attachments - C).*) 1-1. 1 (bo
�• b 1 II //,r 1 �
application fee `^ ` / t' t J �r J 13 I C[A^t

I
-- 5.800
i ITe�I�,�i��,.�•lL1rlES POSTAL )ft Nli 1� ORDER �000
61513149058 950120 285601 **50*00
U. S. DOLLARS AND CENTS
SERIAL NUMBER
YEAR MONTH DAY POST OFFlCE ,
CHECKWRITER
PAY TO� � IMPRINT AREA / `/ !.
FROM
AD
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ADDRE , �( � �I
COD NO. OR -
USED FOR viz,
�,� PC • 13 to • . l� wa. of e y
':0Q0\OD,aQ.O�21. 6 L 5 L 3 L490 58��'

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
)-Z 's property located at
(Nafne�o€ Property er)
(Lot, Block' Block' Roadd, 'eetc. i
i
on in N.C.
(Waterbody) 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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
To be filled in by individual proposing development)
i70Gt14�' of � r l��Gi�T

ADJACENT RIPA_RIPN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
( Lat, Dic �7k, Road, etc.)
on , inyamkI C'a N.C.
(Waterbody) (.--tend-/oE' County)
He has described to me, as sho%ar. below, the development he is
proposin Vathat to do and, I have no objections to his
proposal«- -- Q -- -f-� -------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by ndividual proposin development)
9 S,a&'cam 1. 0 v— d6
5D t S s AL
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e
Print ggWAM(t. VeAW, D.M.D.
209 1st Avenue Southwest
Tavinrsville NC 2R921
Telephone Number
70'4 r-3-2-- -232-`t
HOWARD L. PLANT, D.M.D.
209 1st Avenue Southwest
Taylorsville, NC 28681