18720_SLACK, JAMES_19970806

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CAMA AND DREDGE AND FILL C`
GENERAL 0,18720
PERM I T
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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 �°* ` -� a L - Phone Number
Address LJ ` ti '� -r•�r. r �n U _e
r
City State Zip " k
Project Location (County, State Road, Water Body, etc.) a" ` ' ' �"''ny r"_� t`! 7 C ! �� r` • i -°'
Type of Project Activity '
PROJECT DESCRIPTION SKETCH �` (SCALE: )
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore b
Basin, channel dimensions � 4-h
cubic yards
Boat ramp dimensions
Other
?' A f
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.
applicant's signature
permit officer's signature
issuing date expiration date
C - 1tz
attachments '"` 1P,
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

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!Boris ;M. Mack-otbi 509606 5993
407 QLhaunei Mr. 919-354-3175
CmeraCD Nje, OC 28594 66-25/531
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Carolinas a Carolinas
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to J a�„�es Q . �•�ac%. 's
(Name of Property Owner)
property located at
�l/I 8,y,y2. ! �r,✓.a.
(Lot, Block, Road, etc.)
on �QdS�C" r����,���-Q , in �s/..e -- Ca t-/eYe �. , N.C.
(Waterbody) (Town and/or County)
Re 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)
u
a Q sc ; S P� �-�'ca�L eKoal a� 4olec.�- a w a® C
—7C 11;�hrl
�l 42,j 141-q4: � 1-e z� ete?�&-wm& LQ —a 714
Signature- '4'4'1A1 ( '
-�r / f- '-v
Print or Type Name
919- '7 - Ra)6
Telephone Number
Date: � i / V % 97

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIF (BOATHOUSE)
I hereby certify that I own property adjacent to vh e s 7� . is
(Name of Property Owner)
property located at d �'��iv d� -2) 2,
(Lot, Block, Road, etc.)
on �Da3 `� ����C . in Z-wl e t a(Q - s — , 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)
4-
7 t&tvz T P
P21 IS 5; eDU�
/j
1-6,�� S
Signature
-P - ��L � � Gtsd � c�
Print or Type Name
Telephone Number
Date: z 3�l