17860_AMBROSE, MARIAN_19970805

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� CAM,4 AND DREDGE AND FILL
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PERMIT`
` aoauthorized bythe State o/North Carolina
Department d the Coastal Resources Commission�
inanarea ofenvironmental concern pursuant to15ANCAC
Applicant Name PhoneNumber
Address -4
City X State Zip
Project Location (Cvunty,State Road, Water Body, otc]
poofProjectAcbvity �1
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore LL�l
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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SKETCH
This permit is subject to compliance with this application, site
drawing and attached Xenom| and specific conditions. Any
violation of these terms may subject the ponniuoo to a fine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
o'comcnuUundvoid.
This permit mug 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 l) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2\ a *hrtun statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
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applicant's signature
permit officer's signature
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attachments
94,
In issuing this pcnni/ the State of North Carolina certifies that
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this project i, consistent with the North Carolina Coastal application fee �~ �
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Management Program.
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