19857_BURNSIDES, BETTY T._19980804

CAMA AND DREDGE AND FILL 1j
GENERAL
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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
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.
State
Phone Number
Zip
(SCALE:
ya
4
applicant's signature
permit offic is signature
i
issuing date expiration date
attachments 17 1
In issuing this permit the State of North Carolina certifies that r�
this project is consistent with the North Carolina Coastal application fee
Management Program.

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ADJACENT R-TPARIAN PPOPERT Y OWNER ST.A "NfEN7-
I hereby certify that. I own property adjacent tc Atfc. / ,--
(PME 9f fropert Mt
property located at'10
klkl k, Road, e?c.) i t.-.2 �� ? Q
0 A/— (!,P� jr-
(Town and/or County)—
He has described tr .1?�r.S f art 7F;'.oW, the development he is prod "sin
and, I have no objections
DESCRIPT,F� 1� '` UWING OF PROPOSED DE,VS. A
(To bA,' . '': ° Y� ,� ` - victual proposing deYelopmen ,)
A" �
Si=natare
2CC/� �i dsan/
Print or Type Name
—af�Q
Telephone Numbs _r
Date: _/S q F _—

RIPARIAN PROPERTY OW. JKR
I hereb � , '- - � I -r� , " -'� 0 f,
MT! Pcoperty adjacent to
propeT-v
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(Lot, Block, Rood,'
7.
yia
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43wri anoja-e
N.C.
to me as shown below, the
U,' that In —cation,
and., to .1q proposal.
AND/OR DRAWING OFPR0?-,'
rn.F he filled in by individual proporin-
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rint OT Type Name
Tele2ho.if- Mwbe.,7
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