21019_ROUTH, WILLIAM AND SHIRLEY_19981026 (3)

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CAMA AND DREDGE AND FILL N° 021019 - C
GENERAL
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 0114. 12 ov
Applicant Name 'A • k _,5HJQuE_q C �UT�+ Phone Number 252. 441•G-s22
Address ' A Ut lDk ZIKC PrAL F-TRTE CO. WD A'REN,J EcL- ST,2,E6T 252 . 241. (A22
City /" DVZHEpo C v-.� State N Zip Z aS671
Project Location (County, State Road, Water Body, etc.) AZU1kc-Errr 4—�146 c'-7,0,10 A<r g33
_ln1 i)�p ? 5,Ai31N 46tct1 i4e ?-A r _ N C- CAm-e-,-zE r Co .
Type of Project Activity 0-,�-19-x'r A IC0 Fr. x SF-r, -PIEZ 0 CrH A -iT x `_��. �f✓i�e}'.TFo.'J�.
61Z To -;�g NO LeEs - -w o 3F'r H l,-rf b06�_ C-A5_Al. MA4- 0 5•u136TVATIF
PROJECT DESCRIPTION SKETCH
(SCALE: n�b�tir
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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.
issuing date
attachments 0 -114, 2
HAesl.v
a licant's signature
permit officer's signature
expiration date
In issuing this permit the State of North Carolina certifies that cN . ram. 4Bt U
this project is consistent with the North Carolina Coastal application fee Cc) Cz.r._rAZA 3441JK
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEKENT
I hereby certify that I own property adjoining Ts
property located at N. C. 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 cf proposed development: (to be filled in by
individual proposing development.)
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name
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phcne number
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ADJACENT RIPARIAN PROPERTY OWXER ST J...
I hereby certify that I own property adjoining j
's
property located at N. C. He has described to me as
shown below, the developmen he is p oposing 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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C-
signa�ure
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name
phone number
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