22359_CLARK, JOHN_19990611

CAMA AND DREDGE AND FILL C 01n
GENERAL NV 223 �-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 <i+h (tr'i=� Phone Number
Addres
City State fvC Zip
Project Location (County, State Road, Water Body, etc.)%7
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Type of Project Activity Er. E.c� E.t,.<�i 14:� 5 t.._ wr•iC_Y
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PROJECT DESCRIPTION I SKETCH (SCALE:
Pier (dock) length
�CL;i,`'ri iMI iCU
Groin length
number
Bulkhead length
wry t-IL I
-r-, V l L
max. distance offshore
rvV
Uv ( 7-i IN
Basin, channel dimensions —
cubic yards
Boat ramp dimensions
Other ; r �"" ' I (—"ft4 ,
i Wr\L ( L A{L4y '
tL� C T. TD EkC >I IN
4- *�
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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.
attachments
issuing date
U-7 -f-I . 2 tom)
t�L
s signature
permit officer's signature
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

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Wachovin Bank, N.A.
NC2871;j
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CLASSIC

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ADJACENT RIPARIAN PROPERTY Oti�N-ER STATEAiEN-T
I he; eby certify that I own property adjacent to _Scat j n 'q u c C [ /4 ►2K 's
(_Name of Property Owner)
property located at ,39 SMAK 1-)21 Vz C 4s;T E,
(Lot, Block, Road, etc.)
on ����fl CfRZEK in M��Rz- i T r�
(W"aterbody) N.C.
(Town and/or County)
He has described to me as shown bellow, the development he is proposing at that location,
and; I have no objections to his proposal.
DESCR MON AND/OR DR.AWZ�iG OF PROPOSED DEVELOPIVIENNT
(To be filled in by individual proposing development)
I_
_�-,5%1 �x5s5T�Nv
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o
Signature
Print or Type Name
Telephone Nrnbe;
Date:

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'S i Q On

ADJACENT RIPARIAN PROPERTY OR ER STATEMENT
I hereby certify that I own property adjacent to � O H N f sine CZ-4- 2 V— 's
(Name of Property Owner)
property located at _ 3 a .S' Xfo2r IIg Z�--As% Fc> 2ye, -r s Moss ,
(Lot, Block, Road, etc.)
on Z9.DNL C'{Zc�K , in N.C.
(W aterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that Iocation,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIVMNI T
(To be filled in by individual propossinQ development)
Sigiature
L L.5
Print or Type Name
2
Telephone Number
Date: 7 / j�f

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