18715_ELLIS, ELTON_19970729

CAMA AND DREDGE AND FILL
GENERAL (' 0 W iN � ��18►�15
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 Phone Number
Address --
City State �'Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
�
?�
PROJECT DESCRIPTION
SKETCH
SKETCH,
�^ e9
...�' >; �' env^!• t,`I U �
(SCALE:
(SCALE -
';� "� �E'� jr��-''-�'
)
Pier (dock) length
Pier
'
/�!-�` '�
ty ! l�` ey. 4.5• .-6;," T
>�'c,% . �
R
�A
�%
Groin length
number
{ _
Bulkhead length
max. distance offshore
i
e
Basin, channel dimensions
¢
"'''^
>�� L
! �!^►
C+e
��
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments 1tl Pf J 2111�eJ de)e� /41
In issuing this permit the State of North Carolina certifies that J
this project is consistent with the North Carolina Coastal application fee,
Management Program. y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to lz K��' is
(Name of Property Owner)
property located at
LS
(Lot, Block,
on �c �,� in
aterbody)
etc.)
(Town and/or County)
N.C.
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/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
t' 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)
Signature 0 4
Print or Type Name r
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEIVIENT
(FOR A PIERIUNCOVERED BOAT LIF7)
I hereby certify that I own property adjacent to _ ZL� 's
(Name of Property Owner)
property located at
W
�-s W
r
(Lot, Block, �bad, etc.)
in
(Wa rbody)
(Town and/or County)
N.C.
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/uncovered boat lift
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 DRAWIN OF PROPOSED DEVELOPMENT:
(To be filled in by Mx�
dosing development)
Signature
Print or Type Name
Telephone Number 7�06
Date: 17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to /-G % ON rZ'&IS is
(Name of Property Owner)
Property located at
eJ44�5: u�a% ' (I.ot, Block, Roid, etc.) '//p& D
on E Id %�D/C % / in , 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/uncovered boat lift
must be set back a minimum distance of fifteen feet (I5') 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)
-TNs —//-g.0
�X/.S71- IV4 SzW 1Vl),1r ,
Signature
zm(�zES
P ' t or Type Name F.F /9./4ieiYC
Telephone Number
Date: �y%�i

ADJACENT RIPARIAN PROPERTY OWNER STA
(FOR A PIERIUNCOVERED BOAT LIF7)
I hereby certify that I own property adjacent to ,�� r r is
(Name of Prope y Owner)
property located at OZS c QJ 1-4-
(Lot, Block, Road, etc.)
on , in iZ,4t1nd ��J �� P, E , N.C.
(Waterbody) (Town d/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/uncovered boat lift
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)
/! d
JLL
� f1JRp�'Cs�
E�
S
- () slaxw,) 9), ��-
Signature
�\ Print or Type Name
0. S M I'T4 -
Telephone Numb r4
��� `35 r
Date: 41 (j

_== ELTON W. ELLIS JR.:-
NC 1855620 PH 919-726 6775
P O BOX 691 _ ---
ATLANTIC :BEACH,: NC 28512 1 3 2 4 -
66-152153, CC
Puy To The Z 19_E
Order Of,Af
0
�TA�HOv>u 0Dollars
--Wachovia Bank of North CaroLna;-N.A. =Pine.Ki 11S urea:NC_28ig7 :' —
_— - - —
I:0 5 3 10 Is 291: 5464 1 1 7 B13 5n■
LAND ,,,,�: 13 2 4 _