22219_LEE, LENA_19990428

CAMA AND DREDGE AND FILL ti
GENERAL ITV 22219 - C- �� f
PERMIT �� �����
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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
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Phone Number
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Address r [�
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City = r f -' z^
State �`� f
Zip
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Project Location (County,
State Road, Water Body, etc.)
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Type of Project Activity
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PROJECT DESCRIPTION
SKETCH
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(SCALE:
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Pier (dock) length?
Groin length
number`>"�`�
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Bulkhead length
max. distance offshore
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Basin, channel dimensions
cubic yards
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Boat ramp dimensions
Other
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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.
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applicant's signature
permit officer's signature
issuing date expiration date
attachments '
In issuing this permit the State of North Carolina certifies that 1
this project is consistent with the North Carolina Coastal application fee�T�
Management Program.

ELTON W ELLIS JR 1913
NCDL 1855620 PH 252-504-3161 66-152/531 CC
1384 MERRIMON RD ,
BEAUFORT, NC 28516 err , 19 (7
Pay To The
Order Of _
Wac6ovin Bank, N.A.
Pine 1Go�11Sl�oren. NC 28557AIA I f-
Memo/i7n,9 t �G , ZLCCl�
i'0 5 3 LO IS 291: 5464 11 7
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Dollars

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFI)
I hereby certify that I own property adjacent to 5-, .et � 4 's
(Name of Property Owner)
property located at suitn/c lEr u) �s 1 '�3oGuE Soad� U 2
(Lot, Block, Road, etc.)
on in /2fzlia -c//i a- 6 /1 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 (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 A, -D/OR DRAWPiG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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nature
Print or Type Name
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Telepho en Number
Date: 1� -o

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
• (FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to ,s
(Name of Property Owner)
property located at Y 6 /(o ScvA:�v1E-oI,-/E- 13o c0 zjw b2 ,
(Lot, Block, Road, etc.)
on � in G��� , , 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 (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.
-------------------------------------------------------------------------------------------------------------
DESCRIPI'ION A.N-D/OR DRAWPiG OF PROPOSED DEVELOP_-MEINT;
(To be filled in by individual proposing development)
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Signature
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Print or Type Name
/- 376 _ '2 )- 2-
Telephone Number
Date: