22216_DANIEL, AL_19990428

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Applicant Name — 14
AMA AND DREDGE AND FILL
GENERAL 1 �T': 2221 6 �"' c P
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PERMIT
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as authorized by the State of North Carolina 11'
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Address 1 ��
City i
Project Location (County, State Road, Water Body, etc.) _
of Project Activity
PROJECT DESCRIPTION
Pier (dock) length!
Groin length-
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number_.
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubip yards
Boat ramp dimensions
Other
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Phone Number d � d — 9
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_ State Zip
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SKETCH-1 } 7 }r ,` r ! it (SCALE:
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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.
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applicant's signature
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permit officer's signature
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issuing date expiration date
attachments C / 1
In issuing this permit the State of North Carolina certifies that C,7`
this project is consistent with the North Carolina Coastal application fee ! ��
Management Program.

ELTON W ELLIS JR 1913
NCDL 1855620 PH 252-504-3161 66-152/531 CC
13B4 MERRIMON RD
BEAUFORT, NC 28516 /9
Pay To The f
Order Of �+� (/
7// _ . n �� f a��oL f Dollars
Wachovin Bank N.A
Pine Knoll Shores, NC 28
557
Memo
g053LOL5291: 5464 LL7L3SO 19L3
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ADJACENT RIPARIAN PROPERTY OWNER STA
EMF
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to
(Name of Property Owner)
Property located at vv e„
(Lot, Block, Road, etc.) n
on in //
(Waterbody) '7/ 1
4 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. I understand that a pier/uncovered boat lift
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.
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----------------- -- - - _
ESCRIPTZON AJND/OR DRAWING OF PROPOSED DEVELOPMENT: _
(To be filled in by individual proposing development)
c1raj- ,,g- U it) 6�� V �, Ii��
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bra � 1
dock
ignature
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Print or Type Name
Telephone Number
Date: /v c �-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOX A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to _ ,,_ ��
(Name of Property �O caner) s
property located at lIr �p W c7 v► �- r e- -
(Lot, Block, Road, etc.)
on
(Waterbody) in (Town , N.C.
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/uncovered boat lift
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.
e-� I do wish to waive that setback requirement.
---------------------------------------- -- - -------------------
DESCRIPTION Al'YD/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature /
Print or TApe Name
Telephone Number
Date: