18781_PRICE, BURTON_19970721

(�P T y ✓ t Cam.
O
CAMA AND DREDGE AND FILL �trj
GENERAL
rod �
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 15A NCAC '
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)'
Type of Project Activity
PROJECT DESCRIPTION SKETCH
r
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
e Number
Zip
t C- Cc,) fiiA
f
wi� -Pf?(.Pce `r
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.
(SCALE
t rr
Y ��p
lip
i v i f `U' Ui s ...
2y
)l
applicant's signature
permit officer's signature
% 7 140- 2/- y7
issuing date expiration date
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.

15-800
�LTNITED S'1'A'1' S POSTAL 310NEY ORDE1�
r,,,,.......M�,.
�656021,4�0783
-P[r.F U. S. DOLLARS AND CENTS
\`
CHECKWRITER
�. -AY TO
IMPRINT AREA
,ADDRESS
4
FROM
ADD SS
YY
AL
CODNO.OR
USED FOR
Vv
NEGOTIABLE ONLY IN THE U.S. AND POSSESSIONS
1:000008.00 21: 6 5 60 2 140 78 1 3ii'

ADJACENT RIPARIAN PROPERTY OWNER STATEMODU
(FOR A PIERIMOORING PILINGSIBOATLIF IBOATHOUSE)
s.0 « rc w
I hereby certify that I own property adjacent to ,s
(Nam of Property Owner)
property located at
(Lot, Block, Road, etc.)
on in 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/boatliftboathouse 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)
A
15it4tTi*ncQ_
Print or Type Name ,
ieiepnone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to r/).�• is
(Name o operty Owner)
property located at
(Lot, Block, Road, etc.)
on ' � ram— �i , in - �'J. :'� , 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 b�inddivmidu"alproposing de elopment)
rant or i ype Name
I
Telephone Number I
Date: I