18410_SONG, YOUNG-DAHL_19970815

CAMA AND DREDGE AND FILL d
GENERAL �`� 018410
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
E
Applicant Name Phone Number
Address , L 4
Cityy ' r Lf j
Project Location (County, State Road, Water Body, etc
Type of Project Activity�-
State
Zip
PROJECT DESCRIPTION SKETCH f, ] 1 (SCALE: )
Pier (dock) length
Groin length j
number e
Bulkhead length
max. distance offshore
Basin, channel dimensions
r
cubic yards '
(4-
Boat ramp dimensions .�.
t OL
Other
J
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's signature
permit officer when the project is inspected for compliance. j
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local issuing date expiration date
f' ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
/ f7
objections to the proposed work. attachments
In issuing this per
mit the State of
North Carolina certifies that /�
this project is consistent with the North Carolina Coastal application fee / a�
Management Program.
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USED FOR
NEGOTIABLE'ONL --IN-THE U.S. AND POSSESSIONS
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ADJACENT RIPARIAN PROPERTY OWNER STA
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to is
(Tome of Property Owndr)
property located at A
(Lot, Block, Road, etc.)
on _,in , N.C.
(Waterbody) (Top0h 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/boattift/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.
DESCRIP"I'ION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Nam
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(N of 47roperty Owner
property located at A')�� f ,�
(Lot, oock, koad, etc.)
on in
, N.C.
(Waterbody)
(awn andlor 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/boatliftlboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
e I do not wish to waive the setback requirement.
V I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Or
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hlai�4�-Signatufe � j-
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Print or Type Name
Telephone Number
Date:
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