25542_MACDANIEL, J_20000501

.i NO"
CAMA and DREDGE AND FILL
G E N E R A L 25542
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
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
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
issuing date
(SCALE:
applicant's signature
permit officer's signature
expiration date
attachments
application fee

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04,:10ioO MON 11:40 FAA 910 32t3 84013 .J-T_ & Sherry Smith i JUD2
ADJAOIIII'I' RIPARIAN PROPERTY OWNER SA
TEMOENT
(FOR A PIER/MOORING paI7VGS1B0ATL n1ROATHOUSE)
I hereby certify that I own property adjacent to l JL +
s
(Name of Property er)
property located at .�� /I �/ Q 62Y -
(I.ot, B31ock, Road, etc.) '
on
(Waterbody) N.C.
(Town and/or otmty)
He has described to me, as shown below, the development he is proposing at that
Iocation, and, I have no objections to his � P1°Po- I underszaud that a pier/mooring P'lings/boatliftftathouse must be set back a minimum distance of fifteen. feet (25') of riparian access unless waived by tne. from my area
Aq-n-q wish waive the setback regtrirement.
I do wish to wave that setba
ck requirement_
DESCRIPTION ANI)/OR DRAWING OF PROPOSED DEVELOPMENT':
(To be"
iri by individ rr'al ProPosing development)
96 S
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Signature
�—
Print or Type Name
c�5 ,2- - -�;;'--2- (--.�;��2-CJ
Telephone Number T'�.
-
Date:
tea•

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(FOR A PLMNODRING PILiNGS4WATV"1B0ATA'0USE)
I hereby certify that I Own pPropaty adjacew to
of pftpe my Owner)
propct�J
Met, Blmk Road, etc..)
N. C_
He hw descabed to sae, as sewn below, ** develmmmt he U VmDosinz at tar
iocarion, aaa, I h2ve no objecti= to his pwpx;�L I Wd=3=d d W- a pialmooring
ss>mt be la back a mininicmn disa wr of fd= feet (15') from mV area
of iiparian access unless waived by me.
I an not w= to wove the setb=k *t+u emeaL
wx wish w Wii&ivr mai scd3wk zequireGmeaL
DESCRIPTMN AND/OS DRAWING OF PROP!'06ID DEVEWFMFNT-
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Signattue
Pilm of ape Name
Telepbow Nnmbex
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