27810_CLONTZ, CHARLES & JANET_20010418

CAMA and DREDGE AND FILL ``" t27810
G E N E R A L
IT
PER M
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
Applicant Name Phone Number
Address
City State zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
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
(SCALE: )
C-) applicant's signature
permit officer's signature
expiration date
attachments
application fee
l

CHARLES E. CLONTZ, JR. NCDL 1555188
JANICE L. CLONTZ NCDL 2988767
PH 919-247-4439
103 CYPR S CT
PINE KNOL SHORES, NC 28512
PAY TO THE
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04/10/01 08:31 FAX [phone] ANES
Apr-'06-2001 03:22am Fro -RSM Mc6LADREY
[phone] T-542 P-002/003 F-889
rA E
I hereby certify that I own property adjacent to I
I
,QY®me of Property Owner)
property iueatod at 1pr �8/ H 10
3 s
pICAO/% Sil�ol� (Lot, Block, Rmd, ete. A
gy- . in 7 /# i/FCS - l�r'�rL'f �4• 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
Pdigsfhoatli boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian acc= unless waived by me. —
I do not wish to waive the setback requirement.
I AO wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEWPIVIENr:
(T'c be filled to by indlsdduat pmposing development)
Signature
/,V R L-e-4A Of - A> 6 LA-5 2"o.�U
Paint or Type Name
/. -6r7 n -,:;� 7 S- 7 S6 S
Telephone Number
Date; V/
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i. 7nF��aDI-11` U)11"71VFJ1[1°J L [,K 3V�YJOJ_C�7NF1
(TOR A PIER/MOORING PILINGSIBOA7UMBOATHOUSE)
I hereby certify that I own property adjacent tovor/eS Janice "'/,,
41, 's
Icr,Q(Name of Property Owner)
property located at `� /6lock t`f &Zall .Silo/C,J j0?j {SS
(Lot, Block, Road etc.
/�
on oirtl in I0Ye-4411 Shires — &&rct Co.
(Waterbod)
Y (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.
i
I do wish to waive that setback requirement.
DESCRIPI'ION AND/OR DRAWING OF PROPOSED DEVELOPAIENI:
(To be filled in by individual proposing development)
Add 60a� G;l�- to exq-fc. y dock,
I d �'/ / - U
Signature
Print or T Name
1. (919) 4&_5,� 5
Telephone Number
Date: 9 1 a 41Oo

04/10/0,1 08:31 FAX [phone] ANES
rr••— —
Apr-06-2001 03:22Pm From-RSN JtGLADREY [phone] T-942 P.008/009 F-89B
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