16962_UZZELL, RANDY_19961205

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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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 t- Phone Number z-2L-- %f%
Address 'I•tl
City A/ln, State Zip
Project Location (County, State Road, Water Body, etc.) �% t s -' =✓ Z"%r ^i
Type of Project Activity
PROJECT DESCRIPTION I SKETCH (SCALE;
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
tom'
cubic yards
Boat ramp dimensions
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�i Other -
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
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violation of these terms may subject the permittee to a fine,
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applicant's signature
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's signature
permit officer when the project is inspected for compliance.
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The applicant certifies by signing this permit that 1) this pro-
/AZs/96 Z/C/97
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ject is consistent with the local land use plan and all local
issuing date expiration date
ordinances, and 2) a written statement has been obtained from
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adjacent riparian landowners certifying that they have no
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objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee " _5 6
Management Program.

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OUTER BANKS MARINE CONSTRUCTION
P. O. BOX 1988 PH. 919-240-2525
ATLANTIC BEACH, NC 28512
PAY
TO THE
ORDER OF
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NOTI�VfTCOM�ANV
lY MOR ENEAD CITY,1 NO -TN CAROLINA� 58) C
FOR Ulr I V 1299S"m
II'000 299511' l:053LOLL2Li:L23LOL
2995
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DATE 531
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DOLLARS 8•
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATUFFIBOATHOUSE)
I hereby certify that I own property adjacent to
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property located at
's
(Lot, Blo�k, Road, etc.) \
on , in �\ 1 1�A I S. N.C.
Wat body) (Town and/or 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the 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)
O Nov 11 ass Ei
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Signs S
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Print or Type Name
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Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
property located at
(Lot, Block, Road, c -
on , in
(Waterbody)-
of
�cXM.A,L
(Town and/or County)
's
.C.
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the 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)
Signature
-g2 z e / , I`c e r"V
Print or Type Name
(�71 9 ) -7ae- -73a9
NOV 1 Telephone Number
Date: /� �/ o Z9 6
00880000wp�060" �