12113_TAYLOR, THOMAS_19940927

I CAMA AND DREDGE AND FILL
N� 3
GENERAL
PERMIT o�
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 ; ; —A
Applicant Name Phone Number
Address
City / State Zip
Project Location (County, State Road, Water Body, etc.) f• !
J r,
ype of Project Ac ivity
Gv/ 1
PROJECT DESCRIPTION SKETCH �,JT (SCALE: )
Pier (dock) length
Groin length
,
number
�.. `
Bulkhead length
or
max. distance offshore I ) f f
Bas s
cubic yards— yi {
i�
Boat ramp dimensions t'
Other
1C r > J
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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.
applicant's signature
`— permit officer's signature
issuing date expiration date
attachments !i f i V
application fee `

X X
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
o-n.4X5 )Y - ( g 5/ 4, C"` is property located at
(Name of Property Owner)
1
(Lo , Block, Road, etc.)
on '.54 , in l 4.fk S ��-� , N.C.
Waterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
1'K G r.a�
Signature
Print or Type Name
Telephone Number

THOMAS A. TAYLOR DL 2213914 6'-12112 1448
KAREN S. TAYLOR DL 2454158
531
PH, 728-2359 HACKWORTH DR. 47—
P. 0. BOX 234 / ^ y
HARKERS ISLAND, NC 28531
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