13134_PINER, JAMES_19940725

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CAMA AND DREDGE AND FILL
GENERAL 13114
At'I,IIc C'N ro
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
Applicant Name 'Jo,"- -0 < P /'r' : , .; Phone Number , 7 gs
Address i 'f� J % -7 _,?
City . e State Zip ri
Project Location County, State Road, Wat r Body, etc.) ,f ! it ti� ' -p'� r r 7f
Type of Project Activity ' f; !✓ ��� `1 G' ° ef
PROJECT DESCRIPTION
Pier (dock) length
SKETCH :;
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Groin length
number
Bulkhead length
'Wax. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
1
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 -
is consistent with the local land use plan and all local
antes, 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
0
v permit officer's signature
issuing date
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

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.... ......
E. W. ELLIS, JR. 66-301531 b
PH 726-6775
P 0 BOX 691 127 BOWEN ST
ATLANTIC BEACH, NC 28512
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PAYTOTHE
ORDER OF
DOLLARS
FIRST CI Q `
BA" -Citizens Bank B.Trust company
",oft`c,:!r,c P
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FOR ZZifL�
i:0531003001:1317311S1,Lo 2756
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ADJACENT RIPARIAN
'sRTY OWNER STATEM:
I hereby certify that -I own property adjacent to
's property
Name p
located at Lo r on
(Lot, Block, Road, etc.)
in j��4�v7`�- i3/�'� 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 pies must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless wai,:ed by me.
r— 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)
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signature
Name
ia� s-r
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR -.A- -P-I ERA
I hereby certify that -I own property adjacent to
TAi*'-_S ��W�� 's property
Name
located at /o 1 SO4 /L., on
(Lot, Block, Road, etc.)
Cf7���G in !'`-✓<i9',t/ f�c- 4' C-./, , 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 pie.- must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
do not wish to waive than 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)
Signature ---
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Name
Phone Number

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