23214_GROOMERS, BENT_19990928

CAMA AND DREDGE AND FILL Go/
GENERAL NV 23214
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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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.
Phone Number
State
Zip
(SCALE:
applicant's signature
permit officer's signature
i , f (.
issuing date expiration date
attachments
application fee_

DEREK S. SMITH
17 03
NC 7836496 PH 919-247-4428
107 HAWTHORNE DR - _
9 66-162/531
= PINE KNOLL SHORES, NC 28512 ..-. DATE
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DOLLARS � oa'i:i: an eeox.
WACH".
Wachovia Bank of North Carolina, N
Morehead City, NC/,�2^8557
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at ;el—�� " Vic vu
(Lot, Blbck, Road, etc.)
on l &R ' N.C.
(Waterbody) (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/mooring
pilings/boatlift/boathouse 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
Print or Type Name
Telephone Number
Date:

. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L , 13" 1 � 20'-s 13, Crave ys
(Name of Property Owner)
property located at 2 2 Y 1?, /�i e ,, rr
(Lo , Block, Road, etc.) '
on e S �9 in 7L�y. ��iL �r� �4 r - C.
(Waterbody) (Town and/or Coun )
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRA`VLNG OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
N©,OM6)
Print or Type Name
Telephone Number
Date: </� 0 A �p