24421_MARKHAM, SHIRLEY_20000104

CAMA and DREDGE AND FILL
G E N E R A L 24421
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.)
Type of Project Activity
PKOJECIF UUJCKIPI[ON
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
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

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ADJACINT REVARLAW PROPERTY OWNER STATUVIENT
(FOR A PI
I hereby certify, that Iown /
property adjacent to
s
kPrPeriY Owner)
ProPertY located at
(Lot, Block, Road, etc.)
on /_4
a-�adyv) - _ _ _z _ N.C.
(Town an�'c®may)
Het�=�s ri���i to me, as shown below, the deQre'o ; location; and, -I. have no ob' Pm� he is proposing at that
jections to his proposal. I underst -gd tl�i a Pig/Uncovered boat lift
must be set back a rtlinimum distance of fifteen feet (15') from nAy a ®era
waived by me. parian access unless
I I;Qt wish to waive the setback requiremeng
I 1 , wish t© waive that setback *equifleme t,
DE.StIUPI-14) \i AND/OR DRAWING OF POO L ,� :
�' DE iVtLUpMCIS7:
Mo be filled in by Yndi Y r e d"�
�-- 4 .�
j Punt or Type Name
��,dlephone Number
Dat.a: /,'Z" —,, � �- ? I

ADJACENT RE'ARUN PROPERTY OWNS STA
(FOB A PlERIUNCOVEREn BOAT IjF
I hereby certify that I own property adjacent to
's
(N a 01' Property Owner)
PrOPertY located at
(Lot, Block,' oad, etc-)
on �
(Town — N.C.
' - a� c�
He ril td to me, as shown below, the
location; and,-L have no objections to hisenu. he is proposing at that
must d set back a Tir�inimum distance of fifteen feet (IS) from a P1tc/uncovered boat lift
waived by me. Y ®f riparian access unles
I Va 4Qt wish to waive the setback requiremend,
I -01 wish to waive that setback rNuiremem
DF.SCJ[ Sri O PROS` -- �__ _
AND/OR DRAWING F t � DL+V e (To be JWed in by y:IOU. rev vsasa a �
Pint or Type Name
Telephone Number o�
Dam: