23697_HAUSEN, GREG_19991210

I
'J
CAMA and DREDGE AND FILL
G E N E R A L 236917-
PERM I T'
as authorized by the State of North Carolina C
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
SKETCH
Pier (dock) Length
Groin Length
7
number
Bulkhead Length
max. distance offshore
f'
Basin, channel dimensions
j
cubic yards
Boat ramp dimensions
Other
State
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 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
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.
Phone Number _
Zip
7
issuing date
(SCALE:
applicant's signature
permit officer's signature
expiration date
attachments
application fee

J LEE HAUSER
PH 919-876-0698
5704 DUMPHRIES DR
RALEIGH, NC 27609
DA'I'fi-
_7 f
State mployees' Credit Union
9 Raleigh, North Carolina
FOR �,I16a( 297
1:253L7701�,91:08r.26L91,288 L72
0172
66-7704/2531
� oa
ARS
e.a

IMPORTANT MESSAGE
FOR
A. M.
DATE TIME -P.M.
M ��reca Let -
OF
PHONE
AREA CODE NUMBER EXTENSION
❑ FAX
❑ MOBILE
AREA COOE NUMBER TIME TO CALL
TELEPHONED
PLEASE CALL
CAME TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
RUSH
RETURNED YOUR CALL
SPECIAL ATTENTION
MESSAGE b,dI(
SIGNED
FORM 3002R
LITHO IN U.S.A.

11/09/ 1999 00: i 9_ 9 459 ]TT IV-E GIFTS t INTE PAGE C1
ADJACENT' RrPARUN PROPERTY OWNER. STAMMENT
(FOR A PLERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to iSePY ' " ate 's
(Name of Property Owner)
pmperty located at -:� Q_ NbeAM WCM C., T ATLkKTM l4
(Lot, Block, Road, etc.)
on t � in -- AJIAL= f 9 N.C.
(Waterbody) (Town anti/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. I understand that a pier/mooting
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
/ Y & ncrt wish to waive the setback requirement.
V I da wish to waive that setback requirement.
----------------------------------------------------------------r--------------------------- --------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Af SEE ATTACUE0 MAW N&
------------------------------------------------------
Signa re
Print or Type Name
e ephone Number
Date: /D Z�

11/09/1999 V30:17 3198927459 COTTAGE GIFTS ,ti, INTE PAGE 04
.ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT (BOATHOUSE)
I hereby certify that I own property adjacent to GRW= �- QCIMJ UWfEIZ -s
(Name of Property Owner)
property located at -aid NC i1-lSl-lC` on-t -m
(Lot, Block, Road, etc.)
on EM ("ANAL , in ATL04M, fgjA , 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. I understand that a pier/mooring
pilings/boadift/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 dg wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
SEE ,al T'ACMED DRAWIN(b `%
Signature
Q4-,-=- Ivy � .-T.-/'o C L
Print or Type Name
-�S-R 63 7 r!-� �s
Telephone NumbeT-
Date: / 0- lr,- 2 l

11f090L999 00:17 9198327459
COTTAGE GIFTS & INTE
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