12144_KLUSE, ART_19940311

CAMA AND DREDGE AND FILL
GENERAL N° 91` 4 4
PERMIT 9
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 15 NCAC
Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
SKETCH
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(SCALE: )
Pier (dock) length
it
Groin length
number
Bulkhead length
i
+— '
a
-_.
—4—
max. distance offshore
Basin, channel dimensions
cubic yards
i<=2-
_
Boat ramp dimensions
OtherIt
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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,
`'`
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
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_
------------
attachmentsly
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
application fee
Management Program.
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ART KLOSE, MD
0604
MOREHEAD CITY, NC 28557
VAYTOTHE
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that•I own property adjacent to
/�. t + % � GS-Q, Is property
Name
located at , on
(Lot, Block, Road, etc.)
in �� �, �,, ,� , N.C.
(Water Body) (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. 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)
C)N L y ck
Signature
Name
rc 1 C,
Phone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
�l ( Is property
Name
located at
(Lot, tlock, R ad, etc.)
(Water ody) (Town and/or County)
. on
N.C.
He 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 (151) 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 DEVELOPIlENT)
- C--<LWZOL6���
Sig at r
Name
Phone Number

Locality Permit Number
GENERAL INFORMATION
LAND OWNER
Name _ #f t4 h U r, - 0 5c_
Address 1 Z 1 (h.LeJ
City _ /�) �vy��-- - State _ C Zip 7, (570 Phone Z`1 3U6
AUTHORIZED AGENT
Name
Address
City
State
LOCATION OF PROJECT I.0-4- Z4
Zip
(If not oceanfront, is waterbody natural or manmade?) ►1 Aq VV
DESCRIPTION OF PROJECT
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Phone
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AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION ! t o tJ.hfdt "Ov -
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline ORW Shoreline Other
PROPOSED USE
Residential Commercial/Industrial Other
SIZE OF BUILDING IN SQUARE FEET
Size of other impervious or built upon surfaces (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline)
SIZE OF SITE IN SQUARE FEET
OTHER PERMITS MAY BE REQUIRED ...
The activity which you are planning may require
permits other than the CAMA minor permit you
are applying for here. As a service we have com-
plied a listing of the kinds of permits which might
be required. We suggest that you check over this
list with your Local Permit Officer to determine
which, if any, of these may apply to your project.
This is not a requirement of CAMA, only a sugges-
tion to help you complete your project as quickly as
possible.
Zoning, Drinking Water Well, Septic Tank (or other
sanitary waste treatment system), Burning, Electri-
cal, Plumbing, Heating and Air Conditioning, In-
sulation and Energy Conservation, FIA Certifica-
tion, Sand Dune, Sediment Control, Subdivision
Approval, Mobile Home Park Approval, Highway
Connection, Others: