12091_HISLOP, JOHN_19931115

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 Resour#esCommission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address{ . -
City L ! (T• State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
Zip
PROJECT DESCRIPTION SKETCH (SCALE:All)
Pier (dock) length
Groin length
number 1
Bulkhead length 1 _
max. distance offshore
i 1
Basin, channel dimensions
_ }.. 4 ..
cubic yards
1 f+
Boat ramp dimensions # _ i
Other.
i
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any t�= �i 1
violation of these terms may subject the permittee to a fine„_. r applicant's signature
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 L permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee'-,r
Management Program.

JOHN M. HISLOP 06-89 2 715
1310 SIOUX DR. 455-5710
JACKSONVILLE, NC 28540 .`
19 66-30/531
076
PAY THE
ORDERER OF
on
A S CITIZENS BANK D O L L A R S
First -Citizens Bonk & trust Company
Jacksonville, N. 540 076
N. lao 9
FOR ZZZ-'�i�!1l4 mRlven
':0S3100300':0?G?12S06 2"2'??llCS;

ADi %C! r R ?ARIAN PROPERTY OVINE'T'_ STAT'EMENT,
I Sebycertiat I own property adjacent to
ebv. o
's property located at
' (Nam` of Property Owner)
zz' 1�*-Ivelt-
Y (Lot, Block, Road,
%etc. ) L
on ��DGy,�/f c/UU/l%�, in C/j ,s�GC./I/-aN.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
c /1
Sigfratdre ,
Print or Type Name
37—(o - 3 -7 Z8
Telephone Number

ADJACENT RIPARIAN PROPERT`" OWNLM STATEMENT
p hereby certify that I own property adjacent to
N ►mot [, property located at
(Name of P operty owner)
0
(Lot, Bloc., Road, etc.
on in AUi3EYLT �S�w , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, _ have no objections to his
NrGpoJal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ignature
Print or Type Name
3Z�0-4s(vq
Telephone Number