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CAMA AND DREDGE AND FILL
GENERAL � BAR
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 c
Applicant Name '' y`' p' r� ° Phone Number'
Address
City State ' L +r Zip 5 `!
Project Location (County, State Road, Water Body, etc.) �° f t'� Y
Type of Project Activity �"'' �'� j 1� �;�' r P_ f�
PROJECT DESCRIPTION SKETCH ,Cr' k1 �� (SCALE: )
Pier (dock) length
Groin length
number
Bulkhead length /V
max. distance offshore G
Basin, channel dimensions
tp
i1 cJ cJ
CJ
C� G9 �
cubic yards
Boat ramp dimensions
_
V
71.
Other
s
T
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
n of these terms may subject the ermittee to a fine'
violation t y � p ,
applicant's signature
imprisonment or civil action; and may cause the permit to be-
come null and void.
!1
This permit must be on the project site and accessible to the
t` permit officer's signature
permit officer when the project is inspected for compliance.
t
The applicant certifies by signing this permit that 1) this pro
"% %
Id
ject is consistent with the local land use plan and all local
issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
r.
objections to the proposed work.
,.�r
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
Management Program.
l.,
..ADJACENT ItIPARXAN PROPERTY OWNER STATEFENT
• I *her by.cortify that 1, own property adjacent'
A-1 I.- a property:_located'at
..Of Property.,Owne
(Lot,,.Block, Road, etc.
tp�^'Vo 64a. in IJAIIVI
(Waterbody) (To wit and/or.-Coun
e as* *described to *me, as shown below, the ddvalopment he is
xoposing at .that 'location, and; I have no. obj eptipns- to .his
:ro osal.
------------------------------
DESCRIPTION AND/OR 'DRAWING OF PROPOSED DEVELOPMENT:
(To be filled -in by individual.proposing development)
& It, C, C 0 CCU e,
Print or TypeName
7qZ,.,
.reephona Number
Date J
: ADJACENT Tti1?}►RXAN PROPERTY OWNER STATEMENT
• I 'hereby certify that I own property adjacdnf,_to- _ .
e s__propext , .located at
: (Name ..of -Pxoperty. Owne) -
(Lot, Block, Raad,.etc.) _
:.on in 'Tw C..,
,S • (Waterbody) (Towit and/or. ,County) .
•3 .•as• ,,d••s• • ed to 'me as shown below, the development he is 1
:He, h e prib , •
proposing • at :that 'location, and; .I have no. ob j eptions` to,.his
proposal •
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DESCRIPTION AND/OR.•DRAWING OF PROPOSED DEVELOPMENT: "
(To be filled in by individual.proposing development)
� J
n °ss"b� � 9-
1- c /
hl- _
0
gnature .
Print or Type Name
Telephone Number ,
•:;; ' Date
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