12841_SLEZAK, RON_19940523

CAMA AND DREDGE AND FILLEMAY
``J"`cGENERAL25 199`
PERMIT --
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as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources andt3gg oasSaI Resources Commission
in an area of environmental concern pursuant to 15 NCAC /t �• ) I
Applicant Name r 4 1. k` Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.) C._
Type of Project Activity
PRO] ECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length
Groin lengthAl
number
Bulkhead length .
7)
max. distance offshore
Basin, channel dimensions N
F
cubic yards ZZ5
14
4�. l r
! lI
Boat ramp dimensions ✓ r�. j !
Other
— t
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-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
attachments
application fee
fi
F
issuing date
applicant's signature
permit officer's signature
expiration date