25648_GRIMM, KEN_20000623

CAMA and DREDGE AND FILL$ _ G
G E N E R A L
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC a
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
Phone Number
Zip
This permit is subject to compliance with this application, site drawing
and attached general and specific conditions. Any violation of these terms
applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
'`�
may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local issuing date
expiration date
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.
attachments
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
application fee

1ST SG,r (RI,71'.) KENNI,TI3 GRIMM
1'It 11M. [phone] WK. 466-2650
104 It. SADDLE I,N.
IIAV111,01;K, NC M5811
PAY THE / ) e iJ
ORDERER OF j-J /(/,
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CREDIT UNION
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit,— ' '�'�� ''t C�eese,vcl?t ra &9
Address of Pz Y: rt �/0 6�
//
f It aye/ack 225.3-z
(Lot or Street M, Street or Road. City & Count),)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
/ I have no objections to this proposal.
rf you have objections to wharf is being proposed, please write the Division of Coastal
Management, Hestron Plaza 11, 151-8, Hwy, 24, Morehead City, NC, 28557 or can (2,42) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings.. breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirctnent.
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Signature Date
A, --
Print Name
((�19 ) 9�
1:' le ephone Nun;bcr With Area Code
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6 k/e/y is
(Name of Property Owner)
property located at //© 6- R fW "
(Lot, Block, Road, etc.)
on //puke ieireg , in (11,4Ve 6Cx,) Ckl9ye-v Cu 1jlz:z , 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.
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: �, /av