17001_JONES ISLAND CLUB_19970226

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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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 15A NCAC `
Applicant Name Phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
State
Zip
(SCALE:
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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,
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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's signature
permit officer when the project is inspected for compliance.
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The applicant certifies by signing this permit that 1) this pro-
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ject is consistent with the local land use plan and all local
issuing date
expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
Management Program.

SENDERems
*m Complete, t and/or 2 for additional services.
I also wish to receive the
■Complete items 3, 4a, and 4b.
following services (for an
■ Print your name and address on the reverse of this form so that we can return this
extra fee):
card to you.
4i,
■Attach this form to the front of the mailpiece, or on the back if space does not
1. ❑ Addressee's Address
permit.
■Write'Return Receipt Requested' on the mailpiece below the article number.
2. ❑ Restricted Delivery
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■The Return Receipt will show to whom the article was delivered and the date
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delivered.
Consult postmaster for fee.
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3. Article Addressed to:
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5. Received By: (Print Name)
6. Signature: (Addressee or Agent)
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4a. Article Number
4b. Service Type
❑ Registered ❑ Certified
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❑ Express Mail ❑ Insured
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❑ Return Receipt for Merchandise ❑ COD
7. Date of Delivery
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8. Addressee's Address (Only if requested
and fee is paid)
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H.
PS Form 3811, December 1994
rn Heceipt

UNITED STATES POSTAL SERVICE
First -Class Mail .
Postage,& Fees Paid
USPS
Permit No. G-10
• Print your name, address, and ZIP Code in this box •
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JONES ISLAND CLUB, INC. 2292
P 0 BOX 8365 PH 919-745-7877
HOBUCKEN, NC 28537
66-301531
PAY
TO THE
ORDER OF C ! 7 L I N011 S J
s i �/ -.. Securiy leawres
DOLLARS00
FIRST CITIZENS
BANKFhs6Clll[ans Bank A dust Company
Boyboro, NC 28515 /!r
p/76ol- C C ....
FOR ?� _ nr
114000022920 i:0 5 3 100 300i:4 7 1 10 249a 7un