17020_WELLS, RON_19970324

CAMA AND DREDGE AND FILL
GENERAL Q�''
PERMIT (:�o-)114!�7-1st -C re�
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 r
ApplicantName
Address
City Ada,
_r. tic
Project, Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number �4 `'' sY`
State /4," K Zip .4' �i / �•
PROJECT DESCRIPTION SKETCH (SCALE: }
f
o
Pier (dock) length
Groin length
number �.
Bulkhead length
4
max. distance offshore
Basin, channel dimensions :Y
cubic yards
Boat ramp dimensions
Other
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.
G
applicant's signature
permit officer's signature
issuing date expiration date
attachments "/- r / 7 // / G)
In issuing this permit the State of North Carolina certifies that C
this project is consistent with the North Carolina Coastal application fee y ,
Management Program.

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I hereby certify that I own property adjacent to zow OE/ l'5 's
II (Name of Property Owner)
property located at 14 �d ,
(Lot, Block, Road, etc.)
on IV-eoVorJ- lPeiZ , in AOrekIAd N.C.
aterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Print or type Name
Telephone Number
Date: 1-/ -