23141_INGRAM, JAMES_19990825

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CAMA AND DREDGE AND FILL (?�
GENERAL N? 231 1--
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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
I '
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
State
r
Phone Number
Zip
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applicant's sigi
re
-S
j issuing date expiration date
attachments
application fee

66-46 2 018
JAMES INGRAM s3� 470
AND/OR JEAN INGRAM 472007991
310 FOREST RD. 693-3209 DATE '.7 Af
OXFORD, N C 27565
PAY TO THE Z� A /� O\
ORDER OF �V
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Central Carolina Bank
and Trust Company 470
CCBOxford,
NorthCarolina 27565
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AM 5 3 L0046 5I: 4 7 200 799 Lei' 20 18

ADJACENT RIPARIAN PROPER��R STATEMENT
(FOR A PIER/MOORING PILING ATLIFTyBOATHOUSE)
I hereby certify that I own property adjacent to's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on ,,QG641,!!!F in �'�a�� / F>� s , 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/mooring
pilings/boatlift/boathouse 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 dQ wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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ignature
Print or Type Name
Telephone Number
Date: eAl A;'/e;'

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit:�'��
Address of Property: 'ram 7' �/��
C��/" /40 ,e
Z7 Cry
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposals � _ �'� /T-
If you hav objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plaza II, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
_� I do not wish to waive the 15' setback requirement.
Signature J Date
A r Z X 14
Print Name
S -
Telephone Number With Area Code

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