10857_General Permit_19920812

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CAMA AND DREDGE AND FILL
GENERAL
PERMITY 10857
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources mission
in an area of environmental concern pursuant to 15 NCAC 7 00
Applicant Name 131 ^-'` t Phone Number
Address.
City, r-!�-c,.�'ti-eat^--a-� State A Zip —
Pro lt. Location (County, State Road, Water Body, etc.)
Type o( Project Activity
PROJECT DESCRIPTION
Pier (dock) length --,'�-�-�
Groin length:
number
Bulkhead length
g./ r"
max. distance offshore
e �
Basin, channel dimensions
cubic yards
Boat ramp dimensions
SKETCH
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.
`J
4
issuing date
_ I
G
applicant's signature
permit officer's signature
expiration date
attachments /t-C /1 C 2 f,/ // d Q r ( / ) r) l/
In issuing this permit the State of North Carolina certifies that 0 �
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 certify that•I own property adjacent to
�oG �` BR R?u94Fr warr%Z► 's property
located at t67— I f19 S'FCS /;IzF'R<</ on
( Lot, Block,
� Road, etc.)
S1( r� r7i/V C c in 1 1.���2/J �l?lJu�iv , N.C.
(Water Body) (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 (15') from my area of riparian access
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 proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
County o
State of
Notary Public
,--1
ignature
Name
� -3 (.? - ss-
Phone Number
My Commission Expires:

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that•I own property adjacent to
4,g2y R?v44lz Cyrs.r% Is property
Name
located at on
(Lot, Block, Road, etc.)
C12661C in A/Fw ic/200 ar�v , N. C.
(Water Body) (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
unless waived by me.
I do not wish to waive that setback requirement.
_ V I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
�T A'r,
County o ���
6
State of
Notary Public
My Commission Expires:
X
Signature
AAb
Name
9/9- 63(,- 0ZS2—
Phone Number

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