16527_DAVIS, MAX_19961219

O
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
01652'"L) a
as authorized by the State of North Carolina i�"i�1i\v'111it
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name. 1 l W`}'
Address
City �
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
Phone Number
Zip
PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length
Groin length
numberLNv.
B-ul.#haadtenuth
max. distance offshore
'Basin, channel dimensions
cubic yards
Boat ramp dimensions
+..
li Other - !
J L
W�
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,
C "` ` '�
imprisonment or civil action; and may cause the permit to be-
applicant's signature
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.
The applicant certifies by signing this permit that 1) this pro-
ro
ject
ject is consistent with the local land use plan and all local
issuing date
expiration date
ordinances, and 2) a written statement has been obtained from
I
adjacent riparian landowners certifying that they have no
objections to the proposed work.
attachments
� r
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
Management Program.