7870_THOMAS, JEFF_19901218

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
7870
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as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the V
I Resources Commission
in an area of environmental concern pursuant to 15 NCAC % {
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Applicant Name r'4i % Phone Number
Address ��7-,
City . - �'S r x-.
Project Location (County, State Road, Water Body, etc,)
j
Type of Project Activity
State
PROJECT DESCRIPTION SKETCH �•u '�� {
Pier (dock) length
,7 Groin length, /7,
- - ---� -r-�j
number
Bulkhead length
max. distance offshore —
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
This permit is subject to compliance with this application, si
drawing and attached general and specific conditions. Ar
violation of these terms may subject the permittee to a fin
fimprisonment or civil action; and may cause the permit to b
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- .i
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
E objections to the proposed work. attachments _
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.
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Zip
I'g,. i-:,4;.-_ (SCALE: -)
issuing date
permit officer's signature
expiration date

ADJACENT RIPARIAN PROPERTY OWM STATEMENT
(FOR A PIER)
I hereby-gertify that I own property•adjacent to
a 's property located at
Name
Owner
on 1 wi-.� in !VGro i� v, C��r,�) N.C.
(Waterbody) (Town and/or County)
fie has described to me, as shown below, the development he is
_.foposing at that location, and, I have no objections to his
::oposal. I understand that a pier must be set back a minimum
ai_stance of fifteen feet (15' ) from my area - of riparian access
unless waived by me.
►/ I do not wish to waive that setback requirement. 6ro k
I do wish to waive that setback requirement. 4 �G-Ictir�
------------------------------ ------•------------------------•
DESCRIPTION ANDLOR DRAWING OF PROPOSED DE�,IELOPMENT:
(To be filled in by individual proposing development)
signat e
Print or Type Nam
Telephone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby pe-rttify that I own property .adjacent to
a C �r�t 1 �'►g err Is property located at
(Name of Property owner)
�0 1— 3o a y /Rem PJ ;
(Lot, Block, Road, etc.)
on inj54e�, N.C.
(Waterbody) (Town and/or County)
Fie has described to me, as shown below, the development he is
_._-opozing at that location, and, I have no objections to his
::-cposal. I understand that a pier must be set back a minimum
Qlsuance of fifteen feet (151) from my area - of riparian access
unless waived by me.
I do not wish to waive that setback requirement. P6C_1C
I do wish to waive that setback requirement. R alk4ri44'
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
J'e
Print or Type Name
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Telephone Number .

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