13076_HALE, GLEN_19940523

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commisksion
in an area of environmental concern pursuant to 15A NCAC !%r`'
Applicant Name ' '" ` r �` _' Phone Number '7 y ��
Address
City, ri State /v f Zip !� v y� 3
Pro ect Location (County; State Road, Water Body, etc.) Cam'''
T pe of Project Activity �� '3 7 / furl < v r !-
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PROJECT DESCRIPTION
SKETCH �T�}� S
(SCALE:
Pier (dock) length
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Groin length—
number
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_ 646 ,
Bulkhead length
axA distance offshore
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'Nhw.,
Basin, channel dimensions_
cubic yards
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Boat ramp dimensions
Other
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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.
i
applicant certifies by signing this permit that 1) this pro -
is consistent with the local land use plan and all local
nances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
r
L� issuing date expiration date
attachments i o
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee U �)
Management Program.

JERRY A. JACKSON
P.O. BOX 1025 PH. [phone] 0118
HA E SCHOOL ROAD
HAVELOCKELOCK,, 66-25/531 NC 28532 r / (SL 617
Pay to tti® L.1 ta/R
N tiainsBank
NationsBank of North Carolina, N.A.
Havelock, NC 28532
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