12068_TIPPETL, GEORGE_19931020

CAMA AND DREDGE AND FILL
GENERAL Np?'"'
PERMIT r-
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 15 NCAC
Applicant Name Phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State Zip
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length I i 1
i i i
Groin length
6 -
number
Bulkhead length !_---- � _ �—t._ '--' i___-( •' !— (� •l.
max. distance offshore
Basin, channel dimensions
1 ,
cubic yardsLi
-
-- f —
1
Boat ramp dimensions
4---—
Other
i
I
7—
�—
L� i
I his 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
applicant's signature
i
issuing date
permit officer's signature
expiration date

3577 H
�r 66-30/531 {�
FAYE G. TIPPETT C �$
6801 FOXFIR EPL.
RALEIGH, NC I
D I
$ �l D
Ir, PAY TO THE D�
ORDER OF O L A R S
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FIRSTns CIanl TIZENS BA 086
Raleigh, N.C. 27602 FOR
257
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