19956_WELFARE, WILLIAM JR._19980706

O
CAMA AND DREDGE AND FILL
GENERAL
PFR&AIT
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
A I' t N Phone Number "
pp scan ame
Address
City
Project Location (.County, State Road, Water Body, etc.)
Type of Project Activity
State
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
i �-
Zip _
(SCALE:
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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,
applicaa ignature
imprisonment or civil action; and may cause the permit to be-
I
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.
The applicant certifies by signing this permit that 1) this pro-
f
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
objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
�q6
this project is consistent with the North Carolina Coastal
application fee
Management Program.

-W. F. WELFAREJR. NC 1309848 - 4566
VIRGINIA R. WELFARE NC 1037748
112 NW THIRD ST PH 919-747-2988 66-152/531 CC
SNOW HILL, NC 28580 19 Od
Pay To The
Order Of.
1 &71 Dollars
�TACHOVIA � �
W.,h.,i. Benk.N.A.
S—. i mi, nC 285xu L
Memo! /1tit�c� �lp LI
1:0 5 3 LO L 5 291: 7 200 8000 5811' I, 566
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIF IBOATHOUSE)
I herebycertify that I own property adjacent to GfJ�t.�t�t.,.n, Jeij"�'s
� P �� � . � C
7 (Name of Proverty dwne4
property located at
(LQt, Block, Road, etc.)
on �, in Cau� ag-V V�L , N. C.
(Waterbody) (Town and/oraunty)
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 individualro osing development)
li7 2 _ 0-HC I: X5 ?� N Q G% %�G�Z�L
XIS I IIV�'- DO C K
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7z?-'s-/9-3
Signature
Print or Type Name
'1l 9-- 7.-2�-_ti i y3
Telephone Number
Date: ri1, / & 9

P 318 429 953
us Postal Service
Receipt for Certified Mail
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0
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Restricted Delivery Fee
Return Recent Stiowin9 f? r
Whom & Date OeiSered
.Q RetumRexiptStnwigblf�lto?i,
r—
O TDTALnPostage Fees 3 $
V) Postmark r Date -'—io
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o_
ao SENDER: I also wish to receive the
■ Complete items 1 and/or 2 for additional services. fOIIOWin services for an
in ■Complete items 3, 4a, and 4b. g
m ■ Print your name and address on the reverse of this form so that we can return this extra fee): y
card to you.
at ■Attach this form to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address
mpermit. d
y ■ Write Return Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery to
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Consult postmaster for fee.
delivered. d
u
° 4a. A ' le umber d
� 3. Article Addressed to: � ,
a >✓t 4b. Service Type m
-/W
cRegistered �' Certified W-
E] Reg s o,
N ❑Express Mail ❑Insured 5
Cn
W N
W ❑ Return Receipt for Merchandise ❑ COD
� 7. Date of Delivery '�
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5. Received y Print Nam) 8. Addressee's Address (Only if requested
and fee is paid) 1°
W !6.Signatu
r Addressee or c Domestic Return Receipt
PS Form 3811, cemfier 1994 /