18620_DAVIS, BERTHA C_19980304 (2)

CAMA AND DREDGE AND FILL
GENERAL �,1 -620
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Re ources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name Phone Number `
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length_
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
- - LP
I his permit is subject to compliance with this appncauon, 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.
,-) r -A
attachments
(SCALE: )
applicant's signature
/ permit officer's signature
j `!J
issuing date
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

v
........ .. m .... ......... 2915
MARITIME SERVICES, INC. 66-152/531
P. O. BOX 3549, 919-240-3928
MOREHEAD CITY, NC 28557
PAY C
TO THE J0 c--
ORDER OF
di nay ---DOILLAR§�
Demm m nxck.
—V ACHOVLAMARITIME SERVICES, INC. —L
Wachovia Bank of North Carolina, N.A.
Beaufort, NC 28516
Ivp
FOR
1120000 2 9 1 Sill -i:0 S 3 10 1 S 2 91: S Ll G 1 0 ?00 3 S116

0
LWJ,txC :,NT 1,UrA.L<-LAN
(FOR A PIER/MOORING P1UNGS1BOATL.1F'r'1N4qATg0VSE)
1 hereby certify that I own property adjacent tv�A1i'tS 's
(Naive of Property Owner)
Propertyloaated at
(Lot, Block, Road, etc,)
(Waterbody) (Town audlor County)
He has described to me, as shown below, the development he is proposing a; 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 ripazian access unless waived by me.
I Lo not wish to waive the setback requirement_
I do wish to waive that setback requirement.
--------------------
DESCRUMON" ANUOR DRAWING OF PROPOSM) UEVEI, VNW,.NT_
(To be JTUed in by individual proposing development)
p
el
Signature
Print or Type Nance
Telephone Number
0

tLa)jA1.i;1N T 1<-11"LU<- v1N OWNEA S'i A 1 t.NIE NT
(FOR A PIERIMOORING PILINGSIBOATZIFTIBOATHOUSE)
I hereby certify that I own property adjacent to��04A (2, f��,�C S 's
(Name of Property Owner)
property located at �/ o' F
(Lot, Block, Road, etc.)
on I� (45 in k f} it rn P,T , N.C.
(Waterbody) (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. I understand that a pier/mooring
piling s/boatlift/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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
IN
P'J
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� } Sig ature
L L
Print or Type Name
2/9- 9P2p -�1
Telephone Number
Date: _ j0 Z 2 %