23580_HOLLIS, BOB_19991103

CAMA and DREDGE AND FILL ,�✓Co/
G E N E R A L 3580
PERM I T
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
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Phone Number `1 t 3
State zip
!De. �-i r c� t��
Type of Project Activity 1 N`)3-ALA ± c�5 Cyr u I raYt 9UL k 1-,�-, � LA . ,✓,
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.
applicant's signature
permit officer's signature
expiration date
attachments
application fee

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Pv'9d �/tortortsoi�r Date
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Pay to the_. V
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Wachovia Bank, N.A.
�.tluyl.,-, NC 28515
For
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O HARLAND
0789 2LL!
$ 50-'
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CLASSIC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENr
I hereby certify that I own property adjacent to o UP e--f kb 1 \ %5 's
(Name of Property Owner)
property located at 3g r] S TA�L�oARO D{� _� ���-� ^ -� 5�►g
(Lot, Block, Road, etc.)
on , in 'b TE1JTaL,. f ►�►v.���o , N.C.
(Vi%aterbody) (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 DRAWLNG OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
�o posh
Z'A e4'
\ WINLt
a Rs N�
vl
Signature
0-4,4 P.Ce s ` - , W A U-� T- �) 5
Print or Type Name
(ac c) (pz goo0
Telephone Number
Date: `72-q lctt

10/23/1999 16:10 2522491819 RANDY GODWIN PAGE 02
'I-X/JAI,r_lV it HWARLAN PROPERTY OWMM STATIIVUM
hcre�y certify that I own ro.02
P PeY adjacent to
(Name of Pruperty Owng)
PrOP=ty located at 39 7 5 za�tR.,. s n �. ,A �, . , , lU�-fePS "60e
(Lot, Block, Road, etc.)
(tii+aterbody) ! f txyto _ —,N.C.
_, N.C.
(Town andvor 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.
DESCREMON AND/OR DRA'VT% OF PROPOSED DEVELOPNIENT
(To be felled in by in&vWjy prvposing development)
Lxv
Signature
Print or Type Name
Telephone Number
Date: