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CAMA AND DREDGE AND FILL
GENERAL ,q, €19704
PERMIT NOV 02 19A
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 t3 i{'- Phone Number
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity t
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Zip
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PROJECT DESCRIPTION
SKETCH 1`�� - jv1 �1c ",A I
(SCALE:
drawing and attached general and specific conditions. Any
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Pier (dock) length
applicant's signature
imprisonment or civil action; and may cause the permit to be-
_
come null and void.
1
permit officer's signature
!
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Groin length
number
Bulkhead length
1110
issuing date expiration date 1,
_ ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
max. distance offshore
1 >jir
' IBasin,
attachments
channel dimensions
cubic yards
6 Management Program.
'k iv4 4 15
Boat dimensions
ramp
Other
This permit is subject to compliance with this application, site
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drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
applicant's signature
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's signature
!
permit officer when the project is inspected for compliance.
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ro
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
ject
issuing date expiration date 1,
_ ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
r' objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
6 Management Program.