13209_FIELDS, FRED_19941108

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PERMIT
auauthorized bythe State ofNorth Carolina
Department ofEnvironment, Health, and Natural Resources and
inanarea cfenvironmental concern pursuant to15ANCAC
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Applicant Name
id,
Phone Number
Address C
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Pier (dock) length r
City re ,:,
State
Zip
Project Location (County St te Road, Water Body, etc.) B
W. P(
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Groin length
number
PROJECT DESCRIPTION
SKETCH
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Pier (dock) length r
t
Groin length
number
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Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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drawing and attached Qenond and specific conditions. Any
violation of these terms may subject the ponniucc coufine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
ecnmcnuUandvoid.
This permit must be on the project site and accessible tothe
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that l) 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 tuthe proposed work.
In issuing this permit the Som 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 expiration date
attachments 0
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application fee