13149_LEWIS, PERRY_19940908

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CAMA AND DREDGE AN
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GENERAL ,r, _,
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PERMIT cg yrm�
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
Applicant Name -, T '—_ �W Phone Number_
Address � A
City . j'' r'' State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
—Zip
PROJECT DESCRIPTION
Pier (dock) length
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SKETCH %' w
(SCALE:
Groin length
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number
Bulkhead length's ✓ t I-
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Wax. distance offshore
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Basin, channel dimensions
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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.
The applicant certifies by signing this permit that 1) this pro-
fs 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.
attachments
applicant's signature
4V
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that _
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this project is consistent with the North Carolina Coastal application fee `
Management Program.

ADJACLNT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
?e,r, e- "; 's property located at
(Namd of Property Owner)
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( Lot, B1ocla, Road e//tc. )
on A,4 g in /o�E CAe� 7� N.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)
P r RP t,J f��er 110'.& bxfA k
Print or Type Name
Telephone Number
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