21100_MANTSCHENKO, NICHOLAS SR_19981106

` CAMA AND DREDGE AND FILL r�� GENERAL N101
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.)
�Y
Type of Project Activity
PROJECT DESCRIPTION SKETCH r ;' ]% , (SCALE: )
Pier (dock) length '.,i•
,L4 E � fit
Al
Groin length. .L ��)'� A% � r �1 + , t ! C eil
2.
number } g .,
Bulkhead length '� �' t 1 ` g' • �} %'�' "'t 4
7)
r
}
max. distance offshore "' .40
— —
Basin, channel dimensions �i� t ! ; if -- �-
f
cubic yards `'--
r'
Boat ramp dimensions
-=-- -'
I
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- /} �� applicant's signature
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.
issuing date
attachments 7 f) / a
�SJUL
application fee
permit
s
expiration date

`�,VITE'D ► J!T,VII'l1A t, jl J4 )"'), 1d�NA A,R17I�A' V �Y��NL4�� 'O ODU
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CHECKWRITER
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PAY
IMPRINT AREA
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ADDRESS
FROM
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ADDRES
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i:00000800 21: 690 LEAL.100 2112

ADJACENT RIPARIAN PROPERTY OWIM STATEMENT
(FOR A PIERIUX0 VERED 10A
I hereby certify that 1 -1111 P1111erty adjacent'to' I
�'s
cAaMOL of nrop
Prowu�y locaW.-it e Ity Owner)
(Lot,
Road, etc)
an
in
*P.rbody)
N.C.
:ver Onz-,Y)
He his, d"cx-bed to me, as shown bejow
l0r-atiefln, andi -1 have no objections to his propm he is Proposing at that
M ost, b ..- twt
�grk a minimum distance Of fiftzer� feet f fbj��. a Pier/uncovered boat lift
waive,b ft
jr. n g,
-�� of riparian access unless
wish to waive the sett ,ack rmqu:vp;,
AQ w','Nh to waive that setbackre4,Jm1rjej,,r.
AND/OR DRAVVIN-'r' OF
�.-
(7,2 be filled in by jr�)gilELOPXIENT:
�0 -TerO
y4cr
' r �A
It Z)�
T
ry
...............
WYL
3jigpwvre
1.;.,mt or Type ne
i �;Icpfion —eWu—m-;;r—
L -Ite: -� ­-

ADJACENT RM TAAN PRGPERTY OWNER
M? A PI. RIUNCOI'F'RED BOAT LIFn `�TEIV�VT
(l
I hereby cemfy that I oven p7rperty a47:icent to s
(Name of Property owner)
p {operty located at,
(Lot, Bidet/toad, etc.) '
( �or-Ad y) in � � L '.:.� N.C.
(Town and/or Oouiaty)
He has dostx, 6ed to me, as shown be,iow, the development he s
location, and, I have no objections to his . al. Proposing at that
must be set back a minirn��.* fteen I understand that spies/ancovered boat lift
�l distance of fifteen f- t (15') from n:y, �;,a, of r pariah access unless
waived by me.
I &— no wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVVJ-ejpNjj;NT:
(To be filled in by individual proposing development)
Signature l
x'nnt or Ar
Type Name
Telephone Number
Date: