21049_CAVINESS, JOHN_19981119

O
CAMA AND DREDGE AND FILL �
GENERAL � �� 021 " 49-- 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
Applicant Name Phone Number
Address''
City t State Zip
Project Location (County, State Road, Water Body, etc.) -
Type of Project Activity
PROJECT DESCRIPTION SKETCH 1 1 r, = h ^� 1 (SCALE: )
Pier (dock) length t J
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards�t
Boat ramp dimensions
tt``
' �"; it 1 F
Other -,...._._..,... `n�
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.
issuing date expiration date
attachments ! �.�� p C � /-/ e d (!
In issuing this permit the State of North Carolina certifies that I q
this project is consistent with the North Carolina Coastal application fee 7 `� / 1 3 �l
Management Program.

Personal Account Information
?IS W- :Sohnson St
ZaIe�c!-,, NC '�'7t/'G
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ADJACENT R I PRRI RN PROPERTY OWNER STATEMENT
[ FOR R PIER/MOORING PILINGS/BORT LIFT/BOATHOUSE
HEREBY CERTIFY THRT I OWN PROPERTY ROJRCENTTO J0hn M. GauineSS
[NRME OF PROPERTY/OWNER)
PROPERTY LOCKEDRT /57 2ay F4,grKers sLagd
IL0T,BL0CK,R0R0,ECT.I
He has described to me, as shown below, the development he is
proposing at that location, and , I have no objection to his proposal.
I understand that a pier/mooring pilings./boat lift/boathouse must
be set back a minimum distance of fifteen feet (15"1 from my area
of riparian access unless waved by me.
I do not wish to wave the setback requirement.
I do wish to wave that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by ind�iuidu proposing development)
�oa^r , o Mi- 6 0
Y
vlCe t Xist 13,Zk4
w'd 7' Aq w1 H X d 5
Tw ,3� Imo; fi s
S16NRTURE:
TELEPHONE NUMBER: li-2- 7�J?'-
DATE: // - 5�_ 9�k'
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