16967_USA, DWANE & DOROTHY_19961217

I
CAMA AND DREDGE AND FILL
GENERAL
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
Usti
Applicant Name Phone t. Phone Number i' '0
Address o'U�l ✓11' r,'
City Ale State Zip
Project Location (County, State Road, Water Body, etc.)
`1
Type of Project Activity ale` k6
;r
PROJECT DESCRIPTION
SKETCH
(SCALE:
Pier (dock) length
Groin length
number
Bulkhead length
�
� t 'c poic 0
'
.�'
;
t
max. distance offshore
�t
1
Basin, channel dimensions
cubic yards
/
1
1
Boat ramp dimensions
t
b
��`
+ - •_
---- _ ,. JtJ �i--
Other
t
( r jt6 11 r Y/
11
'
1
_
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments 0 J// %G°`
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
f/ t.
application fee :., —

REMITTANCE ADVICE
COASTAL MARKETING & DEVELOPMENT CO.
PH. [phone] FAX [phone]
6752 GORDAN ROAD
P.O. BOX 10605
WILMINGTON, NC 28405
1321
PAY /�/L/'y',�
AMOUNT�'`�J/? DOLLARS
OF
DATE
TO THE ORDER OF
DESCRIPTION
CHECK
NNUMBERl
11
40n
FA
/K967 e
FIRST CITIZENS BANK AND TRUST CO.
HAMPSTEAD VILLAGE SHOPPING CENTER
HAMPSTEAD, NC 28443
11'00 1 3 2 1,15 1:0 5 3 100 3001: 3 5 3 20 1 1 24811'
66-30/531
H11DES
CHECK
AMOUNT
$ c5—d.O'
AUTHORIZED SIGNATURE

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent t
property located at
I.ci-�3 CC
°s
(Name of Property Owner) rf
(Lot, Block, Road, etc.)
on ��� ,� r �;� , N.C.
(Waterbody) (Town andloi 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)
Si ature
Print or Type Name
Telephone Number
Date: 2- 1 c-- �Z 6