8042_WATERS, WILLIAM_19910530

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Commission
in,an/ /^M

area of environmental concern pursuant to 15 NCAC '71J " J,200
Applicant Name vy I I lL G rk/-,> Phone Number
Address f?
City 1/ -V L1 State zip
Project Location (County, State Road, Water {Body, etc.) t`-f' 1 S c d N - AJ`c—
oq
Type of Project Activity
D u 5e
PROJECT DESCRIPTION
Pier (dock) length
SKETCH (SCALE: )
( '
e /
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other RL A r' 4 try
i
This permit is subject to compliance with this application, site(
drawing and attached general and specific conditions. Any %4
violation of these terms may subject the permittee to a fine, A U lc—; J
imprisonment or civil action; and may cause the permit to be- ` applicant's signature
come null and void. /
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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 - 7
permit officer's signature
expiration date
In issuing this permit the State of North Carolina certifies that Q
this project is consistent with the North Carolina Coastal application fee_
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby-gertify that I own property.adjacent to
(Lot, Blc
OIl
(Waterbody)
's property located at
k, Road, etc.)
in , N.C.
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 u;:de:rstand that a pier must be set back a minimum
distance of fi . tQA:: -Feet (15 ) from my area- of riparian access
unless waived L-y Ira.
I do not wish to waive that setback requirement.
1/ I do wish to waive tlat setback requirement.
---- --- - -0/a o------------------ -------------- --
DESCRIPTION AND/OR DRAWI
(To be filled in by indiv
OF PROPOSED
proposing cieve
t) H
S
Print or Type Name
9i4517- 0� 47Z9- a 949
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property.adjacent
(Name,:c
(Lot, Blc
onR/'/'K44 ,
(Witerbody)
to
's property located at
k, Road, etc.)
in Alm, 6 Cd a ,. No
(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
unles wai ed by me.
!'Y I do not wish to waive that setback requirement.
do wish to waive that setback requirement.
------------------------- - t--..-_------------------------------
'3 DESCRIPTION AYWO L :�l NG OF :PROPOSED ELOPMENT:
(To be f illed in h- individual proposing elopment )
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V) o� 01 6.4rJ
Q. q
Signature
/7 .
Print or Type Name t
Telephone Number