26161_JACKSON, DANNY_20000707

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CAMA and DREDGE AND FILL � V(
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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 .fId , 2 %c
Applicant Name PJN'IPhone Number .S/
Address i.J..) „vw� c r' P
City
OF t -;?tnN
Project Location (County, State Road, Water Body, etc.) ;^ ,,
{'"T1tCEN'i -K Nf VJF PIVF R
State
Zip 7 SQL
Type of Project Activity I+ 2 A. 2x E �� A `i' t! + n T
Ln��w0t> iF- T.
PROJECT DESCRIPTION SKETCH
Pier (dock) Length - z `-
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
/\f(.- rw,TI
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.
-, -1 .. Ci
issuing date
. VIF D
(SCALE: hfNl )
applicant's signature
permit officer's signature
,- 1 - D
expiration date
attachments
application fee

ADJACENT R'PARrAN PROPERTY O
(FOR A PIER/UNCO� STAT��r
VEREd BOAT Idp`l)
I hereby certify that I own property adjacent to D 8K 717N
(Na®e o� pro s
property located at PAY Owner)
(Lot, BIock, Road, etc.)
on U S ��E`P in P m L i c 6 C D i Vit�ody) -� T' - N.C.
(Town;;;e;aj t.®
He h8LIq descrg i to me, as shown below, the de�relo an
location; and, -I have no objections to his p' he is Proposing at that
must beset back a r nimum distance of fifteen feet (15) from L�e /uncovered boat lift
waived by me. Y f raparan access unless
aQ-_qQt wish to waive the setback mquiremenE
I A! wash to waive that setback requiremew,
DF.St ��; N AND/OR DRA
WING OF MO L,+, ;M be y- -
.filled in by h'Wvff ral Proposinga
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Paint or Type Name
E -2-
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STA
MIINT
(FOB A PlERIUNCOYEO BOAT- IJF27
I hereby certify that I own property ad
.lacent to
c� �� of 's
(Name of Property Owner
property located at )
(Lot, Block, Road, etc.)
on �-U � - -
cly)IM
m i cp C:d_U
• (TownC®Y) N.C.
He h`L descrgl��i to me, as shown below, the develop Iocation; and, -I. have no ob' gym, he is Proposing at that
must be set back a ridnimum lance of fifteen feet Ss Proposal. I undes^sta�� t a Irx/uncovered boat lift
waived by me. ) from my a of nnparian access unless
--'- I IM wish to waive the setback
requirement.
I wish to waive that setback mquiremew,
DE.SCHWI T)h AND/OR DRAWING OF Y'RO i�:DE I
' fa be , filled in by inch missal p'7ap0sa�
S-
Print or Type Name
Telephone Number
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