14796_MEHLIN, FREDERICK_19950828

CAMA AND DREDGE AND FILL
GENERAL"
PERMIT �P
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 0 Af00
Applicant Name,
Address
City
f ,fA/D Phone Number ;s��at !� '"g0 • V�
Project Location (County, State Road, Water Body, etc.)-`"
Type of Project Activity JT d5
State
zip 64 76:7
PROJECT DESCRIPTION
Pier (dock) lengthEZZZI
SKETCH
x
eVIAJ_
(SCALE:��
)
i4
T_ $
Groin length
er
number
Bulkhead length—"j
x
's
_
I
i
max. distance offshore
Basin, channel dimensions
cubic yards-
Boat ramp dimensions
i
I�
Other
-
y
i r ,ram ! i i
kF, lk
�
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.
�T applicant's signature
0 k- /4 -atl
permit officer's signature
issuing date expiration date
attachments Y' �1
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
r
application fee r ' r � �% f

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7 m
FREDERICK MERLIN 51-741712111 P.O BOX 15106762 19
MIDDLEBURY,
GT
$ g6), L 0
PAY TO THE DO L L A R S
ORDER OF
1144
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Savings Naugatuck Bank
NAUGATUCK, CONNECTIGUT 06770-0370
FOR 0 L 2 0 300
50 3 0' 6
u■
i:2LLL74L78�:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
-?E�r2elo v/(E/y 's property
located at Z8 Z OA LL� �2 /�� on
(Lot, Block, Road, etc.)
r�
�CES'�_ eoAy. � C� in �N.0 11/yoLL �Hc��2E� N.C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do 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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Date
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Sigy1ature .11
Print Name
9/ 9- e76— I F70
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
-f-rzeGO W,!Fpz-w 's property
located at _ 28 Z &9-4 L"LC4F on
(Lot, Block, Road, etc.)
N.C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at
that location and I have no objections
to his proposal.
I understand that a pier, pilings and
dredging must be set
back a minumum distance of fifteen feet
(15') from my area
of riparian access unless waived by me.
I do not wish
to waive that setback requirement.
I do wish
to waive that setback requirement.
Description
and/or drawing of proposed development:
(To be filled
in by individual proposing development.)
rWsTA`/ 4r/oq or-
Mc 1N7-z-r4 L-0 1--4 Aj,g SHo,eLC9rvA,-e�
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of �xi STi cog ►�� rE.eo c'd �s��-L,
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Sig re
Print Name
Date
Phone Number