21480_PETERSEN, JAN AND NEILL RAY_19990303

CAMA AND DREDGE AND FILL
GENERAL
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PERMIT A/
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
Phone Number
City
Project Location (County, State Road, Water Body, etc.)
State
zip
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Type of Project Activity
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PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards -
Boat ramp dimensions
Other
SKETCH (SCALE; NONFC
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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
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issuing date expiration date
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In issuing this permit the State of North Carolina certifies that � -7-)w
this project is consistent with the North Carolina Coastal application fee
Management Program.

iAN L. PETERSEN
NEILL L. RAY, JR.
PH 483-2003
207 LITCHFIEID PLACE
FAYETTEMLE, NC 28305
Date '3 /b /6 7 -
2735
66-30/531
PAY TO
THE ORDER OF
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FIRST CI ZEN BANK
FIRST -CITIZENS BANK & TRUST COMPANY
FAYETTEVILLE, NC 28302
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1:0 5 3 L00 3001:000 10 2 5 4 LOu' 2 7 3 5

Z 259 153 497
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
n + „on fnr intcrnatinnal Mail (See reverse)
Sent to �'. sGNEGkE/z
stet/-E�tS Ci�G�r
Post ice, State, & ZIP Code
Postage
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Certified Fee
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Special Delivery Fee
Restricted Delivery Fee
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tostN 's
(Name of Property Owner)
property located at _ L, ��T 7 �, �,// : / L
(Lot, Block, Road, etc.)
on / Ae YJ w C114&,,ygz= L , in 0A i� ry� % , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number
MAR Date: .�. �.� F 95�