13052_PAVOLONIS, JOHN & HILL, BOB_19940421

�- CAMA AND DREDGE AND FILL
GENERAL `"jL'..0a�-� - C ri
"
PERMIT
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 J �% / r 0 0
Applicant Name ' 'j %�L I,,ry, J � -- 1 C Phone Number I 3
Address C` !�' �?� _�.. f i e T '' ! f, C c� f,
CityState.
Project Location (County, State Road, Water Body, etc.) s�'<4; n ^ i
Type of Project Activity i s7� f Ash /� '.o�'�e-,
zip
PROJECT DESCRIPTION
SKETCH
(SCALE: )
Pier (dock) length
Groin length
number
Bulkhead lengthj__._..
p.,,,,.,,,
�
f
�i } i
$
ax. distance offshoreAJd
F—� )
1i
—
or7T
Basin, channel dimensions_
'
I
cubic yards
Boat ramp dimensions
-j—
i
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.
applicant certifies by signing this permit that 1) this pro-
4s.,-ponsistent with the local land use plan and all local
Winances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
v.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fe

Personal Account Information Redacted
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR Ate)
SFPrLL j4L-(-
I hereby certify that I own property adjacent to l�19F/r is
property located at YY Dt*)f..-! 6f I i eff �LD cjgUS ,,A\-(
(lot, block, road, etc.)
on fiio©/4 t / 6tt T in L14i4T1 C 'i:�C 4 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 15 feet from my area of riparian access unless waived by me.
I do / do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
Signature
Name
Phone Number