16968_TYMINSKI, KEN & JUDY_19961217

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CAMA AND DREDGE AND FILL
GENERAL `F= ^ 016968
PERMIT
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
Applicant Name Phone NumberrG
Address
City *Y ,) ;; State Zip CY��6o
Project Location (County, State Road, Water Body, etc.) lei `r
Type of Project Activity ` �� ' ' } Sr>i{%
o
�F ( t< w`
PROJECT DESCRIPTION SKETCH (SCALE: C� }
Pier (dock) length f
r 1
Groin length
r _i
number —
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
t 1
�.�. ,3
i � (
L'
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
i
permit officer's signature
issuing date expiration date
attachments 6?H• /2uo
application fee � -) /� '' �''� e— 15�-o

COASTAL MARKETING & DEVELOPMENT CO.
PH. [phone] FAX [phone]
6752 GORDAN ROAD
P.O. BOX 10605
EiEama
66-30/531
WILMINGTON, NC 28405
1320
H11DES
PAY
AMOUNT
OF
- DATE
/�
DOLLARS
TO THE ORDER OF
CHECK
CHECK
AMOUNT
-DESCRIPTION
NUMBER
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FIRST CITIZENS BANK AND TRUST CO.
HAMPSTEAD VILLAGE SHOPPING CENTER
HAMPSTEAD, NC 28443
AUTHORIZED SIGNATURE
II100 1 3 201I' ':0 5 3 100 300': 3
I
5 3 20 1 1 2 L,BII'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
's
(Name of Property Owner)
(Lot, Block, Road, etc.)
on �V�� �rt^I C- , in �?c�' } ��' �; �Cuti� , N.C.
(Waterbody) (Town an-'d/4 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
S' nature
Print or Type Name
4 � �; - G 0-9/
Telephone Number
Date: Z ��