10803_General Permit_19920520

- CAMA AND DREDGE AND FILL , r
GENERAL
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PERMIT.L., ,� C e� -: �~ 10803
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources�and ;thWesou", ission
in an area of environmental concern pursuant to 15 NCAC r
Applicant N a s• , '� / ( J /� Phone Numberiz.' � ram;?
Address
City
PrI tion (County, S
Type of Proj&Kt Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length; eG]�
max. distance offshore
Basin, channel dimensions _
cubic yards
Boat ramp dimensions
Other
Body, 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
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.
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In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
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(Name of Property Owner)
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's property located at
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Lot, Block, Road, etc.)
onRQtq(;° A/ CAIAE:�/2 , in &QD/ --V9)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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
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Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Lot,
on 111M'C?dnl ,
(Waterbody)
's property located at
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in ✓�19'�/ �5��4�147 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
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Telephone Number

GENERAL PERMIT APPLICATION INFORMATION
APPLICANT'S NAME: a �,
(Fityst
�LLING ADDRESS:
N
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PERMANENT) "
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TELEPHONE: WORK ( ) ��� — �j Cn , � HOME (2a) Z of 2-' 6 X 3
CONTRACTOR'S NAME:%h�� � „j � /�/� rf n/ TELEPHONE NUMBER 7,-� g r `% b 7
PROJECT LOCATION: N.C. Hwy. # SR # Road/Street Name
Waterway Name A irk (o 4 4 CX�,61K County M 9 £ ,�
Town A?4D10 -r-5zq^,1A Subdivision
PROJECT ACTIVITIES:
PIER: Total dimensions of pier from MHW to platform
(Length) (Width)
'T' or 'L'-head platform
(Length) (Width) (Number of Mooring Piles)
Water depth at end of pier,
OT HOUSE/BOAT LIFT: Length
Number of Piles
Number of Mooring piles
Width
Water Depth
BULKHEAD: #1 Total length oC 41 /
Average distance waterward MHW
Maximum distance waterward MHW
#2 Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length Base width from MHW
EXCAVATION: [MAINTENANCE 'ONLY']
Length Width Depth of Cut
Adjusted water depth on MLW Existing water depth(s)
Estimated Cubic Yards (length x width x depth/27)
• Type of spoil: Sand Mud
Dragline Backhoe Hydraulic
OTHER STRUCTURES: