12290_SMITH, CHRIS_19940511

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CAMA AND DREDGE" AND FILL �
GENERAL d � 4 �� v ��� �� aIA
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Re,e,� Commission
in an area of environmental concern pursuant to 15 NCAC ! y C3+�'
Applicant Name
Address `� z
City f t<<
Projectt Location_Kounty, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
State Aj t:' Zip
PROJECT DESCRIPTION
SKETCH ` .
a t. �;;jt �) �-
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SCALE:
( Ur r"
Pier (dock) length
Roil - -"
Groin length
number
Bulkhead length
i
• j -- j ! t
I
t
max. distance offshore
Basin, channel dimensions
cubic yards
_1
I
J
i
Boat ramp dimensions
Other
J
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.
pplicant'sifiature
/ 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 application fee
Management Program.