21502_PAGE, JESSE AND MARTHA_19990317

j CAMA AND DREDGE AND FILL
• GENERAL N" 02" 512
c. ,
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
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
SKETCH
State
Phone Number
Zip
(SCALE: /U )
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.
attachments
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fees
Management Program.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
Name of Individual applying for Permit:
Address of Property:
(Lot or Street #, Street or Road, City & County) -) ,"
CAI —
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.
y I have no objections to this proposal. V
If you have 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.)
L I do wish to waive the 15' setback requirement. %
I do not wish to waive the 15' setback requirement.
--vz'
Signature l Date /
U fA C� nCZ-c7 =1�St.l�f V
Print Name
�qL/Telephone Number With Area Code

v. i_, �__� -ram __ _ �__ __�__•-r___ ._ r�;_,G 02
r
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: s J E RA C, Z
Address of Property:
C� CAI' cwc.a i1v 4 0. C 4—
(Lot or Strut #, 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.
wI have no objections to this proposal.
If you have objections to what is being proposed, please write the Envision of Coastal
Management, Hestron Plana 11, 151-B, Hwy. 4 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
{f you have been notified by Cerr(fted Mail,
WAIVER SECTION
I understand that a pier, dock mooring pilings, breakwater, boat house, lift or sandbags must be
set back a rrunimum 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 IS' setback requirement.
I do not wish to waive the IS' setback requirement.
Signatur ' Date
Print Name
Telephone Number With Area Code

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y I, -te D. Phillips hereby
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t ?, yecertifies ta

JESSE W. PAGE, III
MARTHA G. PAGE
PO BOX 857
SWANSBORO, NC 28584
FIRST CITIZIINS BANK & TRUST COMPANY
PITTSBORO, NC 27312
L-053 L00300l:4 2 L 7 24756311-
4957
DATF.Z177
99 66-30/531

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01/01/1994 00:03 91954255429195425542
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