27012_CHURCHILL, RAYMOND B._20001106

ANC Eva, J
CAMA and DREDGE AND FILL ,,��_
� G E N E RA L �
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC f% /
Applicant Name Phone Number
Address
City State zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project 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.
issuing date
applicant's signature
permit officer's signature
expiration date
Attachments
application fee

RAYMOND B CHURCHILL ��7(441d741'4
102 ARBORVITAE DR
ATLANTIC BCH, NC 28512
1508
Date /
l /4/, /�0 80-568/ 1012
Pay the K � 10 © .
Order of
Dollars
EXPENSECODE United Missouri Bank
Fide/i[y Warsaw, Missouri
Investments
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Wheat First
Butcher Singer
Serving Investors Since 1934
Karen E. Eutsler
P.O. Box 1596
400 Tryon Palace Drive
New Bern, NC 28563
[phone]
1 [phone]
Fax [phone]
V %eat Firstj3utcher Singer is a trademark of Wheat, First Securities, Inc., Member New York Stock Exchange

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Wheat First
Butcher Singer
Serving Investors Since1934
Karen E. Eutsler
P.O. Box 1596
400 Tryon Palace Drive
New Bern, NC 28563
[phone]
1 [phone]
Fax [phone]
Wheat First Butcher Singer is a trademark of Wheat, First Securities, Inc., Member New York Stock Exchange

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to d N�P/
' C 1J JA C�h i� 's
(Name of r Owner)
property located at %%/,� ,� c 7y%/}ir �0 u l /��� ®✓ c`
(Lot, Block, Road, etc.)
onFLILC kncB�asec Ca v , in � e &e // 54re,s Cur�eH e- t , 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
X I do not wish to waive the 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)
7
blvz71Z C/.
Print or Type Name
7/
Telephone Number
Date: 02

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTlBOATHOUSE)
I hereby certify that I own property adjacent to 1 ' t N C.
(Name of Property Owner)
property located at 154 o c k /V k 0 N o 1�a t
,,C� l , (Lot, Block, Road, etc.)
on 0 ini-e l�N6�� S Ne ui in /t'iuc// Aa�-eS r'I Ph et, 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
—ze I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Print or Type Name '
Telephone Number
Date: ��©