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CAMA AND DREDGE AND FILL,
GENERAL ��i`.. 2 534
A c
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 > I / __ I / 0" q / q o r
Applicant Name ~'' L
Address `y (' ' } .
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City �-
Project Location (County, State Road, Water Body, etc.)
Phone Number %l
State Zip 7 1
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Type of Project Activity hu i ICA _oa
3�
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PROJECT DESCRIPTION SKETCH r 5 ` jt.� %��
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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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,
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.
�y applicant's signature
permit officer's signature
issuing date + expiration date
attachments ' v A � � / � �� � V / �y�
applicationfee
MUD BUCKET DREDGING, INC.
ATLANTIC BEACH CAUSEWAY NCDL 8039839
PO BOX 3355 PH(919)726-2191
ATLANTIC BEACH, NC 28512
66-30/ 133 1574
Date d4l."
Pay to the arOrder of 4)C-4 1 „ _ I $ Ary
n n.
x
Dollars
%U!J
FIRST CITIZCNS 133
V F 11.C'1tizans Bank & Tr t Company
JFIAllanlic Beach, N.C. 28512 1
3 T 1
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For � n�
1:05310 3001:00 L3 1216067311- 0 L574
OGorkrgmakan GUARDIAN® SAFETY BLUE WDBL
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to
/� 726 -l09-7-
�Gl'(��'/f��2!%�G/ o ��i[l eSVA:1 %1�%g211,1 's property
d,
located at z/� i Aelr(C �C'�i �AUS' r%4G/ on
/9�avE S,ovr.�0 (Lot, Block, Road, etc.)
A Q C E S S in Aj A,46'� /C N. C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that 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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i I„-� %�7L�/��/i/�eL� ��C,fv✓�j�� O h -go -AT 112-4 A�1110 'X qO'J
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Date
Date
Print Name
PrV __(N%�7 C/
Phone Number
Phone Number
R."
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ct
I hereby certify that I own property adjacent to
a/,4Kt)E61 o (2-Atl.S'&,1A,; 1 % //- 4 is property
located at 7— ATZI 4ti/T(C tS,�ACM (?4//S'6?,)4G1 on
r-QoQ06: S'o(Lot, Block, Road, etc.)
vuo
A(?CESS in Afj�LC 664C14, , N.C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that 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.)
l 1�'T,4 LL A 1 10/,/ O FEE-F D
i l,Li fl�17C-r/�I/�hleL� l --Lr �� i� C7 1 l�D� ) � �`�. - 3b' X qD �J
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Date
_�+
Print Name
7---1& - 2 tq r
Phone Number
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