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CAMA AND DREDGE AND FILLIF
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GENERAL 016545,
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PERMIT
as authorized by the State of North Carolina
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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
ip_Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length
SKETCH (SCALE:-
number
SCALE:
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
'7
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- applicant's signature
come null and void.
This permit must be on the project site and accessible to the j permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject
ro ject is consistent with the local land use plan and all local i suingdate expiration®
ordinances, and 2) a. vdow"r--statemifying -that they r havee--no attachments
tect -from
ad'acent., riparian landowner -s- certNf ire
objections--to--the proposed-wofk. x
In issuing this permit the State of North Carolina certifies that (�
this project is consistent with the North Carolina Coastal application fee
Management Program.