10733_General Permit_19920410

Applicant Narrge
Address % `l /
City . 0 Qlt
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal, Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7}1
Phone Number - a
Project Location (County, St
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length.
number
Bulkhead length
7 �71
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
, etc.)
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
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applicant's signature
permit officer's signature
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issuing date expiration date
attachments
application fee l �
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I herebycertifythat I own property adjacent to
-C &� Q. 141 1F,\�' -'C"\ �ti 6 (Z is property located at
(Name of Property Owner)
--3.5, '3� pnyis �.�.0.i � oJ IT
((�� (Lot, Block, Road, etc.)
on Dckuis Co�uan�tiitvl_Wgl-�o _� in fltiyis 2�.C.
(Waterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Print or Type Name
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Telephone Number

STATEMENT
djacent to
is property located at
TGA I ❑ aa{�- �- - Lt -35� -3(0 Davis Cake �o4J
(Lot, Block, Road, etc.) I
on �4��� L��, k�,t� �� �Lr , in 9-'U �S N.C.
(Waterbody) (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.
CRIPTION
(To
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L.c 3s
P=...J fl-a— r{.r ..ra. 39' I..Z
trx.a c.e....{a b._. V.-"
Lot "r.
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Signature
R;c-L.vJ Q. Scott -
Print or Type Name
5-- 51)6-:�
Telephone Number