16671_TEMPLE JR, BURWELL_19970707

CAMA AND DREDGE AND FILL
GENERAL
PERMIT rcW/
1
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 Number
Address''
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
SKETCH--
(SCALE:
)
A I
{
like
Groin length
number
Bulkhead length
t
max. distance offshore
Basin, channel dimensions
i
cubic yards
Boat ramp dimensions
Other
_V�w—.
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.
attachments
application fee
i
applicant's signature
permit officer's signature
issuing date expiration date

k.Q I ' I U(
SO
Reservations 1-800-HILTONS

BURWELL TEMPLE JR.
PH 919-393-8300 SSN 244-48-3089 1055
P O BOX 566
SWANSBORO, NC 28584 19 66-30/531
PAY C \ I� I C
THE ORDER OF \� JJJ I � v
\ DOLLARS cfeatures
{{{ t included.
C TI NS BANK 342 Detail
Is on back,
FI T-CI I NS BANK & TRUST COMPANY
S NSBO NC 28584
FOR
�.Ilddll
i:053 L003001:34 L7599 L 2L,ii' L055
OOESICNEA CHECKS • BLUE CLASSIC

, . .2 3 ,�) 7

Lopcet 10/650 C11,
Each tablet contains:10 mg hydrocodone bitartrate
(Warning: May be habit -farming) and 650 mg acetaminophen.
6
bock FOREST PHARMACEUTICALS, INC.
phormo yo
pony UAD LABORATORIES
ST. LOUIS. MO W141 St. LOUIS, Mls"url 63 5
Pl'vaer&Gau"e
0099-8100
Please see full prescribing informational back of this pad.

Location: l �9 Field F.ep . /A d
Phone:Date of Report:
T
Description of Project:
Date Project Reportedly Comm7ltte: (�
(1) Do the measured dimensions of the devElcpme 'iffEr from those
indicated in the permit .an rkplat?. Yes/ 'G Have all permit
conditions peen satisfied? nye
/ No
COIP?!fE7NT :
(2) sedJ!-,,e?ltctlOn and Erosion Control: Has pErm1 seeae , crassa=d,
or G �.rier"w lss sta_ t 1 1 Z ed all d15turbed areas ' YE= No
COI�'�NT :
t
(3) Future Monitoring and 7nforce
or enfcrce_ient action needed?
COY-H-ENT :
Yes
r
Is far-I"her lnvestlQctlon