23192_HOLLER, ADRIAN_19990820

y f
a
j1
CAMA AND DREDGE AND FILL J
GENERAL 23192
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 `
Phone Number
Address
City
State
Zip
Project Location (County, State
Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
SKETCH'
(SCALE:
)
Pier (dock) length
Groin length
number
Bulkhead length+"
v
•
max. distance offshore
Basin, channel dimensions
\
cubic yards
��
y
Boat ramp dimensions
r
U I
r
Other
-
p.2
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any j r.
violation of these terms may subject the permittee to a fine, k
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 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.
permit officer's signature
issuing date expiration date
attachments
application fee �''

R. ADRIAN HOLLER
ANNETTE JOST HOLLER DL 3227719
309 BROOK LANE
NEWPORT, NC 28570
PHONE [phone]
PAY TO THE
ORDER OF
• r
10601
G 66-152/531
DATE ' 1
(l!
�O s.wmr iesmn.
DOLLARS
oa.u. o. max.
ACHONA
we�tio,ie st, Na.
Momhead City, NC 29557
f
FORE 314a
i:053LOL529t: 5469 L13LIL9u' 060L
o wauNo

08/20/99 07:45 FAX [phone] T D EURF.
vostaiau 10;UO P&A 40ZfZ6,%1V44 1 0 bumb
�pry � . 1' ► �. f..' �+1 `Y /►ill; _`� _ _ Y�►_ l ►1f:-
I hmby certify that I own property adjacenpto A PR IA-V Ts
Ohnne of Property Owner)
proper h=tedat -�oV!,sg,� g1g4low.4-
9
Block, Road, etc.)
C-- N.C.
(Waterbody) (Town. and/or County
He has described to me as shy below, the development he is proposing at that location.,
and, I have no objecdcas to his prvpvsW.
DESCRMTON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be Bled in by individual proposing devekpment)
MA) V-rSAt A.k-- � ISFUlc *rf 6AJ
M
ti
Print or Type Name
2q -� -L yg �
Telephone Number
Date_ 4� , 1 c) , Cj c

08/19/99 16:05 FAX [phone] T D EURF. au
I hereby certify that I own property adjacent•to A DR IAA
(Name of Property Owner)
property located at CZ' 7 1 3-fWoO,v�
(Lot, Block, Road, etc.)
'S
on - 4�:'Ioe, in /Ul C-- L, 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.
DESCRUMON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To he filled in by individual proposing development)
MA) 1VAA4-J—r-
-1FFy—C-JWA 1 a,cj
An
R <A-rj ! /'
Signature
Print or Type Name
Telephone Number
Date: