13219_HENDERSON, JOHNNY_19950125

CAMA AND DREDGE AND FILL n
GENERAL.�-.`!.9
"ate 1
PERMIT 3 �3 . _- - _
as authorized by the State of North Carolina4
Department of Environment, Health, and Natural-Resroarces•ar1d7t�2�sa?9Rsources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name a`
Address '2
City . ra t
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
State ��� Zip i
PROJECT DESCRIPTION
Pier (dock) length7q
SKETCH-�������o ~. i�JOMALE:_�
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Groin length,
number
Bulkhead length
max. distance offshore
Basin,channeldimensions_
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 they have no
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
1
permit office ,r's signature
1 I
issuing date—�e�xpiration date
attachments M
4 0c) _
application fee

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
(Name:'%f Property} owner)
n ' 4� / h
(Lot.
's property located at
, Road, etc.
on �'�L�✓,�����✓ ���a,��,t, i n �i l�2 . �c� �/ ����y - N . C .
(Waterbody) (Town and/or Couniy)
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 must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
_aa L//I do wish to waive that setback requirement.
f
v
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ig atute
T6/--Plf 7--(
Print or Type Name
Telephone Number 4

ADJACENT RIPARIAN PROPERTY OWNER STATMU NT
(FOP, A PIER)
I hereby certify that I own property adjacent to
(Namd of Property Owner
's property located at
(Lot; Block, Road, etc.)
on cat"
�lZ�r�.�yl� `/�c./_c 2�✓., N.C.
(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. I understand that a pier 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 that setback requirement.
y I do wish to waive that setback requirement.
L�
DESCRIPTION AND/OR DRAWING OF PROPOSED
(To be filled in by individual proposing
t)
Signa��rd/
TT V T �-Gam= S
Print or/TV-PP- Name
Lif
' Telephone Number ,�