14742_DEELY, BRIAN_19950630

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and th_e Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
3
Applicant Name 1_J,-1 1 , *� '� Phone Number ," — f Z
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Address
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City . r State _ Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity--
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PROJECT DESCRIPTION
Pier (dock) length
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Groin length(i�
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number
Bulkhead length
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max. distance offshore`
Basin, channel dimensions
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cubic yards
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Boat ramp dimensions
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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-
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.
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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

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a UNI1'1�;D STATES POS"rAL31
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61514157565 01
SERIAL NUMBER YEAR, MONTH DAY
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ADJACENT FdRA.P ANT PROPERTY ONNTNTER STATENM NTT
(FOR A PIERIMOORING PILINGSIBOAYLIFIYBOATHOUSE)
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I hereby certify that I own property adjacent to '
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.) U
on in N. C.
(Waterbody) (frown 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. I understand that a pier/mooring
piling s/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I d2 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Sighature
Print or Type Name
c(I of !� 01
Telephone Number I
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATE, AT NT
(FOR A PIERIMOORING PILINGS/B0ATLIfY1B0ATII0USE)
I hereby certify that I own property adjacent to
(Name of Property Owne
property located at
(Lot, Block, Road, etc.) 1
on r�'� J� i r ,,� , in � c% ,�� , N.C.
(W rbody) (T wn 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
✓ I L4 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he,rlled in by individual proposing development)
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_________________________________________________________________________________________________________
ignature .r
Print or Type Name
rfe� r7
Telephone Number
Date:

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