21043_HENDERSON, JAMES_19981028

CAMA AND DREDGE AND FILL
GENERAL N`00 03104� ' 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 �� " '3 Phone Number l
Address
City State Zip 2
Project Location (County, State Road, Water Body, etc.) r'
Type of Project Activity i 2 k
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
SKETCH
I
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.
.V
(SCALE:
( appucanrs signature
i
v permit officer's signature
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that „ �^
this project is consistent with the North Carolina Coastal application fee ''`9 1 �'
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER SUA
(FOB A-'IF'R'' NCOVERED BOAT LIB
I hereby certify that I o F>xoperr y adjacent to A'f /'/�=
(Name of �P�YO�er4 j
Property located ate�� L� s
on
(Water�fi.
(Town an �� . _L_7 _ _..a N.C.
or CounxXiII
He has desri tas shag it below, the level
location, and, I have no obi ins to his � sal. opment he 1 � ,-�;��� at that
must be set bads a ft en I understand that a 1;;, ,�'4�tiy .`1ve.:ed how
lift
anini.mra c�i � ce of fifteen feet (15') from my area of paA.if,t� a a5 u ess
waived by me.
*sh W waive the setback
-, Imquirement.
to that setback requirement.
DESCRI.0,N,,0�.Ic� ]DRAWING OF PROPO,� S�il
I3`:
rj C�'
41a �--
I
Print or Type Naiaite ---
'telephone Number
Date:

ADJACENT RIP
(FORMU PR PERTY OWNER STATIIEIT
PREP BOAT Z,IFn
I hereby certify that I own property adjarnt to
(Name of Property Owner) ;
PrOPeZtY located at
(Lot, Blocky Roa , etc,)
on
(WaterbodN.C.
(Town and/or County)
He has described to me, as show:.,a below, the development he is
location, and, I have no objections propo�n
must be set back a J�ons to his P-�. I understand � a t��
minimum distance of fifi ,z�a feet (15') {gym m that apier/uncovered b I:
waived by me. y area of riparian access uq iel
I no wish to waive the setback rquirement.
I dQ wish to waive that seiback rquiremenx.
BESCRIP'I'AND/OR r)FLA?'�T NC-' OF PROPOSED D �..-._�
(7'o be lv&-j i�
(T E VEl-,taP?? F n
9 development)
VY
z '
�lrt 0 -
Signature ,5
J
Print or Type Name
Telephone Number
Date: