23249_JACKSON, ADRIENNE_19990923

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CAMA AND DREDGE AND Fill
GENERAL
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
Applicant Name
C7t"�'-,4i;.,�,. '\ r _:a,-r Phone Number
Address i��i� �i�r, rl us rxl z
City 'IaeF State Zip
Project Location (County, State Road, Water Body, etc.) /( G '�� -' lc%tE14
Type of Project Activity °'%ll
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PROJECT DESCRIPTION
Pier (dock) length
SKETCH (SCALE:
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Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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I
Other
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 be-
o,; applicant's signature
come null and void.
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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.
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The applicant certifies by signing this permit that 1) this pro-
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
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objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
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this project is consistent with the North Carolina Coastal
application fee (f
Management Program.

�ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I her/e�-\0c%by certify th-7a�At I own property adjacent to FL 32a0'Z
,'�(�/�(�� C2KS'o hl �O�- Z£�o t s property
located at _ Z�g OAKS--C4r
(Lot, Block, Road, etc.)
on
` 150Q l�E d U) /0 i n �(�l L� =nIpLL �- N . C .
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual proposing development.)
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Phone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1';36
I hereby certify that I own property adjacent to FL 3ZOfj'�
�t01Q(rAtA%E J�iC�Ks'O QO4F� Z&'o ��/9s property
vQlJe on
located at _ 2�� �AKL-fir
o(Lot, Block, Road, etc.)
` R(9q o6- in Vf 21fpLC �l-� � N.C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual proposing development.)
F�ZE(D�4 C�Gr���1 t o r l CrD L-/tilt q 4 r�CT
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Signature
Print Name
Phone Number
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