17012_SMITH, LORRIANE_19970314

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CAMA AND DREDGE AND FILL
GENERAL ®.'��+i
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the,5r I ReUsources Commission
in an area of environmental concern pursuant to 15A NCAC tr 11 e{
Applicant Name :1 r r, - �, Phone Number
Address (
City 14` ' State Zip -
Project Location (County, State Road, Water Body, etc.) t n ' "9
T pe of Project Activity t' t
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
SKETCH Y- Gc d T .14 �
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.
attachments
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applicant's signature
j permit officer's signature
-7
issuing date expiration date
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In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fe 7
Management Program.

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ADJACENT' RIPARIAN PROPERTY OWNER STATE
MENT
I hereby certify that I own property adjacent to Lorra,� I I
� �r� ,s
(Name of Property Owner)
Property located at
110�b�
, Block, Road, etc.) in
(Waterbody) , N.C.
(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
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Telephone N6mber
Date: C'