10886_General Permit_19920910

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina �d
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7 H — / a r' r
Applicant Name
Address
City . Zkf A 1,tM Lc/L C
Pr iect Location (County, state Road, W ternBody,eic.)
Type of Project Activity (-1 Ott l k .'
Phone Number C 3 9 / ;­ d
61 � d tate /(/ . zip J ti /°
PROJECT DESCRIPTION SKETCH (L 1' (SCALE:
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
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.
This permit must be orf 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.
1 / ► applicant's signature
Permit officer's signature
issuing date expiration date
attachments _ i // �/I <- �/7 �)
application fee

1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that own property adjacent to
S (2R P"n us A FA- Is property
Name
located at 10 S- jig, 4 ►gin , Cc v K i
(Lot, Block, Road, etc.
MKOH1
?off {3G.cQ CBti��C�� in �(1F� %�F�Zi�� CJ?19 , 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)
1�0 LR�6�, r
C,
P�-
Fuc w191
Signature
Name
t- atiG - ce- 64--7
Phone Number

• 0S-/NJ/ 1992 16:46 FROM FOLEY Y FOLEY IAC. TO 19197266062 P.02
►1
AWACENT RIPARIAN PROPERTY ODlMM STATE :ENT
(FOR A PIER)
I hereby certify that I own property.adjacent to
property located at
(Name of Property Owner)_
(Lot, Block, Road, etc.)
onin -
-?T
(Waterbody) (Town d 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 (150) from my area -of riparian access
unless waived by me.
I do n not wish to waive that setback requirement.
I do wish to waive that setback requirement.
�-----------------------------------------------
DESCRIPTION Ah'D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fw11ed in by nd;tjidual proposing development)
Signature
Print or Type [A -
__
Telephone Number
TOTAL P.02

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