13198_FOGERTY, TERRY_19940921

CAMA AND DREDGE AND FILL
GENERAL
�P
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 f J a — ' /!�'' �_ / % '. ,
Applicant Name Ec, ' 1 _Phone Number .ijl Z-` `� 3.ti� / f
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Address 0- ' ,,-�- i ! ' i ; t. -, '` 11p) � r
City �-'^ 1' "� Y• C'` State
Project Location (County, State Road, Water Body, etc.)�—
1 % } c' / -z / i/ 6
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length '
number
Bulkhead length
Wax. distanceoffshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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SKETCH l'W� !%%/� ll?l,tj? % `''Y d' �_ _ 'u (SCALE: / )
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-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro -
Sis consistent with the local land use plan and all local
hances, 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.
issuing date
applicant's signature
permit officer's signature
expiration date
attachments - /7 1
application feel

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U.S. DOLLARS AND CENTS
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
. (FOR A PIER)
I hereby certify that•I own property adjacent to
!-a 9 property
located at Coai'L I on
(Lot, Block, Road, etc.)
clecalc in AIF(t) ( eti CPQ90 F-70 N.C.
(W er Body) (Town and/or County)
Fie has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (15') from my area of riparian access
unless waived by me.
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)
elf
V sign�ajture
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that -I own property adjacent to
I� I ' 's property
located at
on
(Lot;'Block, Road, etc.)
EPILC in AI1:u) 2 eti Cc� 7J N.C.
(Wa,ker Body) (Town and/or County)
Fie has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
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)
4r-
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Name
Phone Number

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