7841_WILLIS, RAYMOND_19901105

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O
CAMA AND DREDGE AND FILL 7841
GENERAL /� S
PERMIT G d/
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
Applicant Name ! Phone Number
Address
City State / Zip
Project Location (County, State Road, Walter Body, etc.)
r
Type of Project Activity.3
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PROJECT DESCRIPTION (SCALE: 9 )
Pier (dock) length
Groin length -
number
Bulkhead length t
max. distance offshore
Basin, channel dimensions.
cubic yards
Boat ramp dimensions
Other'
i
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.
ca,
/ applicant's signature
attachments
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.
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.
ca,
/ applicant's signature
attachments
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I herebb certify that IIoow�n Droverty adjacent to
A 1�11�111'JC�zi/o 11/ L C///1/S ' s proDerty
located at 41V, 0
W�/VIE— LZ2!XlyF_ _ . on
(Lot, B19ck, Road, etc.)
in iN. C.
(Water Bodv) (Town and/or Countv)
He has described to me as shown below the development he is proDosina at
that location and I have no objections to his DroDosal. 1 understand
that a pier or bulkhead must be set back a minimum distance of fifteen
(15) feet from my area of riparian acces?F, 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 DroDosed development: (TO BE FILLED IN BY
INDIVIDUAL PROPOSING DEVELOPMENT)
i ture
Name
15 Phone

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own Droverty adjacent to
AVE
located at
s vrooerty
. on
(Lo4. Block. Road. etc.
in — cS �5 �/� C 1E-�E1 N. C.
(Water Body) (Town and/or County)
He has described to me as shown below the development he is pr000sinR at
that location and I have no objections to his croDosal. 1 understand
that a pier or bulkhead must be set back a minimum distance of fifteen
(15) feet from my area of riparian acceas unless waived by me.
I do not wish to waive that setback requirement.
V I do wish to waive that gotback requirement.
Description and/or drawinX of or000sed development: (TO BE FILLED IN BY
INDIVIDUAL PROPOSING DEVELOPMENT)
�z Zee-
,, -Signature
84 C Ue� i1 fez t
' Name
Phone r