13135_PAXTON, TOM_19940725

CAMA AND DREDGE AND FILL
GENERAL
PERMIT A i cr 13,ael r A op
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the;Co/7 tal.Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant ame ` Phone Number
Address � .; i/ ca '� . c �r 2 �/ ->� 7, ` 1 4
17
City '�'i V `�'r !t % State 1-t- ; i Zip : -Ili
Project Location (County, Sta e Road, Water Body, etc.
J
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
SKETCH S (SCALE:
6
I
)
Groin length
a
i l—i I
�f I
I f I I
number
Bulkhead length
�
--
I.Mlax. distapce offshore
I
Basin, channel dimensions _
"
cubic yards
Boat ramp dimensions?
Other
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 -
Wis consistent with the local land use plan and all local
ances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
applicant's signature
1 � ,
permit officer's signature
r'
16
issuing date expiration date
attachments t C A r 7;4 / r r)
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee ��` �J c/ r

E. W. ELLIS, JR. 2755
PH 726-6775 "-301531
P O BOX 691 127 BOWEN ST
ATLANTIC BEACH, NC 28512
Z 19
PAY TOHE
ORDER
ORDER OF
' � vd
i���T DOLLARS- --- --- ���DOLLARS�,� C IZENS i»
Nnl-nC
AnonBont A trua Company (�
nc �h, 2ASIi �
� 131,E
FOR
1:0531003001:1317311S Ilmon 2755
A

IN
ADJACENT RIPARIAN
DPERTY OWNER STATEMENT
I hereby certif�y% that -I own property adjacent to
�(J %Yt / J3,1' /O%✓ is property
Name
located at '/' 7 % , on
( Lot, Block, Road, etc.)
ivy L- in #- I Z e ✓7-' - `- �-v� , N . C .
(Water Body) (Town and/or County)
R
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 pie?: must be set back a minimum
distance c,fifteen feet (151) from my area of riparian access
unless_ wa,i•.:ed by me.
do not wish to waive that setback requirement.
""I" I do wish to waive that setback req
uirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDMDUAL PROPOSING DEVELOPMENT)
Signature
Name �--
Phone Number

ADJACENT RIPARIAN
:OPERTY OWNER STATEMENT
I hereby certify that•I own property adjacent to
Al) Is property
Name
located at zo on
(Lot, Block, Road, etc.)
Gf4 w 19 2 inN . C .
(Water Body) (Town and/or County)
Y
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 wai,;ed 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 INDMDUAL PROPOSING DEVELOPMENT)
f
SicJfiature
Name
12���_
Phone Number

a
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify
j1Althat -I own property adjacent to
om /r /pi✓ 's property
Name
located at _ i % �G Gc �v A tv !` , on
(Lot, Block, Road, etc.) v
(f;gAl*L- in rT'�-�✓l�-` li � /�� , N.C.
(Water Body) (Town and/or County),
ft
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 pies: must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
un ess wai,.: ed_bv me.
:Z do not wish to waive that setback requirement.
''V"" I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDMDUAL PROPOSING DEVELOPMENT)
Signature
Phone Number

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