10854_General Permit_19920811

Applicant
Address p-��
City L!/`-"
Projgq Locj
CAMA AND DREDGE AND FILL,
GENERAL'
PERMIT � , �� NM 10854
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the tal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Phone Number 6 Ll 9 7 r
on (County, State Road, Water Body, etc.)
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Type of Project Activity
State iii���
zip —. ) 6 7 f
PROJECT DESCRIPTION
Pier (dock) length
SKETCH (ijj �f�"A.
(SCALE: )
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Groin length.
number
Bulkhead length
max. distance offshore-t�
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Basin, channel dimensions
cubic yards]
Boat ramp dimensions
Other
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. n //
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.
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issuing date
applicant's signature
permit officer's signature
expiration date
�%. ,
attachments 1tt 11,4
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee 4-G'1 47 "

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I/ hereby certify that I own property adjacent to
/ice A i A l a
ame of Property Owner)
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's property located at
�L(i'Y1 a ' !/lw+�
(Lot, Block, Road, etc.)
on a-rc-�-� in Q�- N.C.
(Water y) (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 �� posing development)
\ MOW
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zloG
Print or Type Name
7a G - 70.2 '?
Telephone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Is property located at
(Name of Property Owner)
i
ZZ3 -t�49, 2/-�- --- ��� 11
(Lot, Block, Road, etc.)
on in %��_� . N . C .
ater y) (Town and/or County)
11
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)
g
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signature
k P.iz MX? koU 1r5
Print or Type Name
`7-Z (, 2 a s'a—
Telephone Number

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