12127_PICKARD, ROBERT_19970117

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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I as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
L in an area of environmental concern pursuant to 15 NCAC
Applicant N me I l' 1 Phone Number
Address
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City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
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Pier (dock) length
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Groin length
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number
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Bulkhead length
max. distance offshore
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Basin, dimensions
channel
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cubic yards
Boat ramp dimensions
IOther
I his 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.
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applicant's signature
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permit officer's signature
issuing date
attachments
expiration date
application fee (' L� 1" t I y

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Ro Q LP2.T P 1 CK P� 2 b 's
(Name of Property Owner)
property located at S 70Y S OV Nb b 2 9 V b—
(Lot, Block, Road, etc.)
on 1= S D U N , in �= M �`2f,} L.� a S L L— , 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/mooring
pilings/boatlift/boathouse 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 the 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)
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Print or Type Name
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Telephone Number
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