26988_CULLAN, RAY_20001101

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CAMA and DREDGE AND FILL �..
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G L N L K A 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
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKFTCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
State
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.
Phone Number
zip
issuing date
(SCALE:
k
applicant's signature
permit officer's signature
expiration date
attachments
application fee

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DEREK S SMITFI (DBA) NCDL 7836496
ROGUE BANKS MARINE CONST 2095
800 NORTH GATE AD PH 252-247-4428
MOREHEAD CITY, NC 28557 Z Z —C,C�
86-752/531 CC
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Wachovia Bank N.A.
Mo�chead City, ry 28557
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to el'i IK4 oo''rv- Is
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property located at 10 ✓e ✓ D r , &' . � // C
(Lot, Block, Road, etc.)
on , in / �� CG/
N.C.
(Waterbody) (Town and/or C unty)
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
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Signature
Print or Type Name
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 9, ktf !/ a i✓4 is
(Nam of Property Owner)
property located at .
(Lot, Block, Road, etc.)
on , in dr < r� f ��'�/ , N.C.
(Waterbody) (Townfind/orCounty)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
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y fo
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Print or Type Name
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Telephone Number
Date: 1/ - 3 d - !�k)