17343_GREGORY, ROB E_19961004

CAMA AND DREDGE AND FILLJ
43
GENERAL r[OCT
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natur osroodxgoa�4p$�&liw
p !�!''��s an a oastaResources Commission
in an area of environmental concern pursuant to 15A NCAC -7�
Applicant Name Phone Numb
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length %`Yr
Groin length
number
Bulkhead length 1'
max. distance offshore
Basin, channel dimensions '
cubic yards
Boat ramp dimensions
Other
State
A r�
Zip i'.:'
SKETCH F, (SCALE:
1 �
IL
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.
/° y /��
issuing date
attachments / YU'► ,
applicant's signature
permit otticer's signature
/ Z
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. Al
5 :-