17026_WILLIW, BILL_19970325

CAMA AND DREDGE AND FILL V
GENERAL A
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 Number V 73
City State zip
Project Location (County, State Road, Water Body, etc.)
PROJECT DESCRIPTION
SKETCH
(SCALE:
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
ev
cubic yards
Boat ramp dimensions
Other
This punnh is subject to compliance with this application, site
drawing and attached Xenom| and specific conditions. Any
violation of these terms may subject the purmiueu to a fine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
This ponniz 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 ponnir that l) 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 oothe proposed work.
applicant's signature
permit officer's signature
issuing date expiration date
In issuing this permit the Smzo of North Carolina certifies that
this project i, consistent with the North Carolina Cov,m| application fee
Management Program.
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