7960_PETERSON, JOHN_19910418

O
Applicant
Address
City .
Project Lc
Type
CAMA AND DREDGE AND FILL
GENERAL
7960
PERMIT
)W (of
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC /71 I
Phone Number (0 ��' a�"2sa
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length 7�
number
Bulkhead length
A, t
""
max. distance offshore
d 3
o T
Basin channel dimensions
cubic yards
do A
Boat ramp dimensions
..-
•ther ��ffim
M
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.
q/61/
issuing date
(SCALE: 0 ,?,/ )
4.1
6
applicant's signature
permit officer's signature
attachments . / V c4 �- 211
U
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application feed C'
Management Program.

ADJACMIT RIPA�RDIT PROPERTY 04dNM STATE
.�(FOR A PIER)
I hereby- certify that S own property ,adjacent to
Is property located a
( Name of property Owner)
(Lot, Block, Road, etc.)
on N.C.
v
(Waterbody) (Town and/or County)
he has described to me, as shown below, the developmerit 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 f i.fteen feet (15' ) from my area - of riparian access
U111ess waived by me.
I do rot wish to waive that setback requirement. '
1 do wish to wa:.ve that setback requirement.
DESCRIPTiC,N AND/On D'.'_11.'11114U O '- XI.OPOSED DEVELOPMENT:
(To be filled .in by proposing development)
NEVV F6A7' llP-T
N
4 Q
Signa re
Print ok Type Name
Tclephone Number

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ADJACENT . PARIAPI PROPERTY OWNER STATEMENT
( FOR A PIER)
I hereby- gerti.fy that I own groper. ty .adjacent to
Is property 1004ted
(name of Property owner)
(Lot, Block, Road, etc.)
on `j3Car�Zg C'� �.ek o in 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. I understand that a pier must be set back a minimum
distance of fifteen feet. (151) from my area - of riparian access
unless waived by me.
I do not wish to waive that setback requirement. '
✓ I do wish to waive that setback requirement.
DESCRIPTION _A!M/On Moil
(To be filled in' by
NEW i36,47 1,1r7'
r\U
OF, PROPOSED DEVELOPMENT:
al -proposing development)
Signature
Print or Type Name
P_
`telephone Number