10885_General Permit_19920902

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 7H / / (? G
Applicant Name � 4 / � 4 �- Phone Number �> G
Address % q 6l R
City, /l/,,P_V State
PROJECT DESCRIPTION I SKETCH PT -
Pier (dock) length
Groin length
number
Bulkhead length
r, f Z'
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
%l
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.
Zip ,) j-�76
(SCALE:
a000t
M
ap 'cant's signature
permit officer's signature
issuing date expiration date
attachments �✓ /7 r
application fee D 77.1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A MW) CLA_J-v k-4 1 A p
I hereby certify that I own property adjacent to
!_ r" H ' s property located at
(Name of Property owner)
(Lot, Block, Road, etc.) I
on`S Ae_7-e , 5 e e_ A'—' in C-,2 Q ✓ C .-✓
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. 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.
'• I do wish to waive that setback. requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
P�
Si4jnature
1�lf 11/ /# g �,,je
Print or Type Name
o� S *_3
Telephone Number

� . MIS !' x• t1101;W;'OWVPLORL
I hereby qQrti,fy that X own prOPK-tY actj acen G
property located at �+ "ti ILA A i � �� —
(tat, h1 k, road �j etc.
can � i� C �E� in 1fA&) d.1i�
(bddy of water (town)
.earth Carolina in Pamlico Wunty. The prc7posal has been describe-6 to me as shown be icjw;
the dcvelOrzentr a ier aikhea st_ra_cture, and the proposed zooattan, and T have no
(c a one)
Qbj=ti ons to the praposai . I understand thst if the development is a pier, i t mu.�t
!,�; set back a minimum distance of 15 feet from ray area of riparian aoccss unless waiv::tl
!;y no wish to Waive that setbacl= requirement.
(girdle one)
.'.h**'AtkX;Rak7ti�icikSf'kS�litkN'Oti1G�S7r**t**�f****kici**icicic*�rlkvl'�f'kik9Cic*kic9F****#lMfi*7:it'�Ciilrlc�tit'h**�c�t*1Y*iS*YthV*+" a :i�
�.riizt).cn and/or drawing of proposed develoj=nt: (to be filled in by indi-%tidual
development.) INDICATE THE SIZE AND i1JCATTQN pF TE E STRfiCIURE AMID ZtiE
EA01 PRQPEny LTNE AND THE WATER.
T'W
(0rijg*anal* must *be*retained �in� the *inSPeCtiOn DeP rtm
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