7847_SOTIR, DAN_19901107

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/—AM/\ AND DREDGE AND FILL
GENERAL
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as authorized by the State of North Carolina, wV' ^
Department ofNatural Resources and Community Development d the Coastal Resources -Commission
inanarea ofenvironmental concern pursuant colSNCAC .
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city_� State Zip
Project Loc4tifn (County, State., Road, Water Body, etc cz�
Type of Project Activity
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PROJECT DESCRIPTION SKETCH (SCALE:
Pier (do length 1;ed f
Groin length.
number
Bulkhead len
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max. distance offshore
Basin, channel dimensions
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cubic yards
Boat ramp dimensions
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Other
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This ponn)t is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms may subject the pormioou to u fine'
imprisonment or civil action; and may cause the permit to be-
come null and void.
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This permit must he 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 l) 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.
/n issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
attachments
application fee
7847
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applicant's signature
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permit officer's signature
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issuing date expiration date

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that.I own, property adjacent to
Is property
Name
located at CA ;'.Q'' �.J l 1 �' � - l,i_ri �•. -�r,. �
(Lo,, Block, Road, etc.)
_( JAX' /�:>__S in N . C .
(Water Body) (T-owm—an�-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 and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT).'
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Signature
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Name
-7 ,;2g J� l W
Phone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
L tAl 5 0 j / S Is property
Name
located at
(Lot, Block, Road, etc.
, on
^(Water Body) (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 and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
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Sign re
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Name
Phone Number