7783_VAN VELD, ROBERT D_19901003

CAMA AND DREDGE AND FILL \1�1�� 7783
GENERAL _ 117783
PERM I T
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development d oastal s s m fission
in an area of environmental concern pursuan o 15 NCAC
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Applicant Name 4 Ph6ne%lumber .0Q0
Address
City �-� State zip
Projeq,lLocation (County, State Road, Water Body, etc.)
Type of Project Activit
PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
r
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 0 the
permit officer when the project is inspected for corn lian�ce
The applicant certifies by signing this permit that 1) thipro-
ject is consistent with the local land use plan and all local
fk ordinances, and 2) a written statement has been obtained from
andowners certi ying that they have no
adjacent riparian
o lee i1-`o7fstt5 e pad work.
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issuing date
applicant's signature
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fees
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjoining Izz'; I TI b4-`
property located at 5vys E--` L14,,,.E on o6JF- 5-0oA-)�
(body of water
in Atlantic Beach, NC. 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 15 feet from my area of riparian access unless waived by me.
(check one of the following)
I do wish to waive that setback requirement.
I do not wish to waive that setback requirement.
Description and/or drawing of proposed development: (to be filled in by
individual proposing development)
signature
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name
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phone number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjoining qaFj LOF% WA L
property located at 5-q 5JA)sEF LA--JUE on 130"% S000KD
(body of water
NC. He hadescribed 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 15 feet from my area of riparian access unless waived by me.
(check one of the following)
I do wish to waive that setback requirement.
I do not wish to waive that setback requirement.
Description and/or drawing of proposed development: (to be filled in by
individual proposing development)
sig ure
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