General Permits (3703)

O
Applicant, NIme
Address i'
CAMA AND B.
,-` it `-t Z TI fr Ciro � CU
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
Phone Numbers
City 'f 1i , State Zip -' KS
Project Location (County, State Road, Water Body, etc)y
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
c
1_4;
SKETCH `
L � '
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.
applicant's signature
permit officer's signature
I �
issuing date expiration date
attachments / ! C ) _
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program. i

MAY-14-1997 10:37 FROM DCM MOREHEAD 919 247 3330 TO G37-3821 P.01
� � _ _ _ _ _ _ .-+ ..-. _ � --. .�� � rn v • • � � ua � » a i �i i .. • 111E �{ ...
' (FOR A FIE IMOORING PJLINGS/BOATLIFT/BOATbl'OUSE)
I hereby certify that I own property adjacent to �co � rs
(Name of Pr rty Owner)
property located at 6 3 O o Aj ('// r—
l ' (Lot, Mock, Road, etc.)
/
on �V fie. in 4,) 6 e,'rJ , N.C_
(Waterbody) (Town and/or County)
He has described to me, as shown below, the deveiopmen,t he is proposing at that
location, and, I have no objections to his proposal. I understand .that a pier/mooring
pilings/boadUUboathouse must be set back a minimum distance of fifteen f=t (15') from my area
of riparian access unless waivers by me. y
I do not wish to waive the setback requireme:rt.
I do wish to waive that setback requirement_
DESCRIMON AND/OR DRAWWG OF ,PROPOSED DEVF,Wp.NM'�'T:
(To be failed in by lindi -&Ual proponng development)
Print or Type Name
Telephone Nurnbe:
Date: J - Z I - 9
TOTAL P.01

MAY-14-1997 10:37 FROM DCM MOREHEAD 919 247 3330 TO 6333e21 P.01
' (FOR A PIEItIMOORING PJZJi'VGS1B0ATUFTIB4ATH0USE)
I hereby certify that I own property adjacent to �(� 4,ey'� 's
(Name of Propertypwner)
pzope< < located at 3 C�
(Zot, Pock, Road, etc.)
on in _ L�_
(W aterboay) (Town and/or County)
He has described to me, as shown below, the developmennt he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/mooring
pzlings/boatlifklboathouse 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.
DESCR.IP'TTON A-'V'D/OR DRAWriG OF PROPOSED DEVELOPMENT:
(To be , Ued in by in.div&rcal proposing development)
c a"-,t 4A I
e o
Print or Type Name.
Telephone Number
Date:
TOTAL P.01