24618_NC DIVISION OF PARKS & RECREATION_20000315

CAMA_and. DREDGE AND FILL
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
G E N E R A L
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal
in �qkenvironmeqta
S 0�S I�`fr pttts�uan�to,1�5 NCAC
L� `f Phone Number
State
�� 9' 24618
Resources Commission
Zip
anu attacneU general anu speunc cunuiu0ns. r-Nny vwiauun ui ufebe rernia applicant's signature
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.
issuing date
permit officer's signature
expiration date
attachments
In issuing this permit the State of North Carolina certifies that this project J, �' OA/V
is consistent with the North Carolina Coastal Management Program. application fee

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UNITED STATES POSTAL SERVICE First -Class Mail
Postage &Fees Paid
USPS
Permit No. G-10
• Print your name, address, and ZIP Code in this box •
NC DIV;SION OF COASTAL MANAGEMEN
HESTRON PLAZA II, 151-B, HWY.24 n
MO'REHEAD CITY, NC 28557 D
[phone] �
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