21400_LONG, RAY_19990107

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CAMA AND DREDGE AND FILL
GENERAL4 021 V10 - �-
_Y 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 % % idpa
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
i°
pe of Project,Activity h
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Phone Number ' — L) 11 5 09
State `. Zip ri 3
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PROJECT DESCRIPTION SKETCH f �; f /i ``, (� (SCALE:
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.
1
ti A
applicant's signature
permit officer's signature
issuing date expiration date
attachments t/ I`� (r %� ! U
application fee! ;/ G�

PAY TO THE
ORDER OF _
D.E.N.R.
50.00
DOLLARS
BRANCH BANKING AND TRUST COMPANY A HORIZED SIGN TURE
WILSON, NORTH CAROLINA 27693 _J
F2755-000 (10/97) \ ��
�R
MEMO/PURCHASER - -
II' S 3 7 30 Soul i:0 5 3 LO L L 2 Ll: LO L 90 L00 9 711'
ElyTiHE�ORIGINAL.`,DO,CUMENT HAS A REFLECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO I VIEW,WHEN CHECKING'THE ENDORSEMENT.>:�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
is
I hereby certify that I own property adjacent toT1 l
property located at
i 1 v la S z� rn�-}}�'V1 �( —P1
(lot, block, road, etc.) 2 , I
' ) L in L f✓ Cat , N.C.
on C- ~
(water body) (t�o� nd/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 must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I d do notewish to waive that setback requirement.
(circ
individual
Description and/or drawing of proposed development: (to be filled in by
proposing development) � 4
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Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
Is
I hereby certify that I own property adjacent to 1 i ^
property located at
(lot, block, road, etc.)
iLl cnl= ('�/`�'� in 'T�� i`�%C fZCH- , N.C.
on }U`��r
(water body) (tower r 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 must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do ish to waive that setback requirement.
4�;)not
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development) ' f \U
3'
T (C-
,/:�- I �-('+ --�
P (L
Udfp'
(!- �S
Phone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
, s
I hereby certify that I own property adjacent to I
property located a
(lot, block, road, etc.)
ffi'.C`— C� L in'�71� I , N.C.
on (water body) (town and/or county)
e is
He has described to me as shown below the development that aproposing
i
and I have no objections to his proposal. I understand Per must be set back a
minimum distance of lb feet from my area of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
(c' 'e one
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
o
Name
Phone Number