13889_KLEIN, DONALD_19941205

Applicant Name
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
� 67
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
9
Phone Number
Address f tV 110 + t= _• "•
City c�� �' _ State Zip
Project Location, (County, State Road, Water Body, etc.)
:
Type of Project Activity ����>�< f ,-� J=
1 J
A E C- ( <<i, ;4= Y /4
PROJECT
Groin length
■
�number
■■■■■■■!�■
Bulkhead length
�..
distance offshore■
__
■�■
■■■■i
Basin channel dimensions
■■
��_
■■■■E
■
4
yards
MMMA
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pill.cubic
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This permit is subject to compliance
drawing and attached general and
violation of these terms may subject
imprisonment or civil action; and ma
come null and void.
y
with this application, site
specific conditions. Any
the permittee to a fine, '� `� ' . ,'�-�✓�'iF
cause the permit to be- .'' applicant's signature
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.
�• ,
4er /99y
issuing date
attachments _>f7
permit officer's signature
expiration date
In issuing this permit the State of North Carolina certifies that ,z `
this project is consistent with the North Carolina Coastal application fee
Management Program.

PAY
TO THE
OF;QER OF
10044
66-301531 t,
I $ ��•Do 1;
D /O DOLLARS
FIRST CITIZENS BANK
First -Citizens Bank &Trust Co pony 471
Bayboro. N.C. 28515 �^ r
FOR
11'0001004411' ':0531003001:471100 07911-
�.�. x,............ ........... ,.....,........_s .... r_ ........,................,
DAVID SIMPSON CONSTRUCTION CO. INC.
RT. 65, BOX 384, 919-249-1381
ARAPAHOE, NC 28510
lait)e
n i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LONA ,) KLEJ M
property located at 51
lot, block, road, etc.
on i in
body of water town
North Carolina in E&M)LI& O County. The proposal has been described to me
as shown below; the development, _ier bulkhead/structure, and the proposed
(circle one)
location, and I have no objections to the proposal. I understand that if the
development is a pier, it must be set back a minimum distance of 15 feet from
my area of riparian access unless waived by me. I d o not Lh to waive
(ci e)
that setback requirement.
Description and/or drawing of proposed development: Indicate the size and
location of the structure ands the distance between each property line and
the water. 5EF- A 1 eve-- F—b pxW /46 . ArT-Ft% NOV, 3,�) l t`i
k
(original must be retained ir�lthe inspections department)
� (�
ignature and date
name please print

C.LOOD INS. RATE MAP 1W .570/t91-0286-8,
z-RTY IS LOCATED IN AN 'A5' FLOOD ZONE,
M'N TtE l00 YEAR Fl 000 BOUNDARY.
-Y IS OF AN EX/STING PARCEL.
'GHTS HAVE NOT BEEN DETERAYNED l3
TRED BY THS SURVEY. .�
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PREPARED BY cv
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%Gh' f 14Rl'?/S , ✓F� N
9-ESSIONAL ENGINEER f
ERED LAND SURVEYOR F
ORIENTAL , N.C.
Y 1, 1994 JOB NO. 1750 _
'" - 50ORWN. BY bjf' N0.
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