28184_DICKENS, JULIAN_20010730

CAMA and DREDGE AND FILL
G E N E R 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 Phone Number
Address
City State
Project Location (County, State Road, Water Body, etc.)
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_ Zip
Type of Project Activity i t. 41 l „t " J E
PROJECT DESCRIPTION
SKETCH
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(SCALE:
Pier (dock) Length
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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 applicant's signature
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- permit officer's signature
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 issuing date expiration date
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. attachments
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program. application fee

TED STATES
tY. % P S/TA SERVICE® POSTAL. MONEY ORDER � ppo7 .'r
8682621,4563 010731D 285700 *100*00
PAY TO CHECKW RITER �� I4� y .,
IMPRINT AREA
ADDRESS FROM
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C.O.O. NO. OR _ `�
USED FOR / � C.
NEGOTIABI F ONlY IN THE U.S. AND POSSESSIONS
1:00000800 21: 8 68 2 6 2 L 4 S 6 311'

ADJACENT REPARL-�N PROPERTY OWNER STATEN EIN7
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to i j{ �' k. ' P g ' 's
(Name of Property Owner)
pro rtyl% ocated at y r�
a r'. e- G/ r,,t #- K ) (Lot, Block, Road, etc.)
on :rhl -erepet s7o / ,in t VJ 0 01 e-0'G!T- N.C.
(Waterbody) (Town a d/or Cou ty)
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 se: 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 du wish to waive ti:at setback requirement.
DESCRIPTION AND/OR DRAWLN, G OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Vame
-_313 -
Telephone Number
Date:

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07/30/01 07:15 FAX [phone] CLIFTON PLUMBING
Iul 30 01 0a:02a Julian Die-kens 553-8051
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ADJACENT RIEPARLAN PROPERTY OWN71EIt STATEtiIEEtiT
(FOR A PIER 000RING PIUMGS/BOA TLIFIYBOA mousF_)
I hereb cert
Y fi �+hat I own property ad�acenr to � . , f ..;•, � �' �' � 's
�^ (Name of Property Owner)
pmpem located at 7 J .: C Y' -1) r .
(Lot. Block, Road, etc_)
On et, as 76 t , _ in T7— N.C.
(Waterbody) (7own and/or County)
He has de=ibed oo me, as shown below, the development he is proposing a- rhac locadon,
and, I have no objections to his proposal. I understand that a pie:/moorin-
Piiitt_s(boadift/boathouse must be se_ back a minimum disrancc of fiher� feet (IS') from my are
Of riparian access unless waived by me_
I do not wish to wave the setback uireme
req nt_
I dIl wish to waive that setback rNuiremenr_
DESCRIPTION AID/OR DRAWING OF PROPOSED DEVELOPNi NT.
(To be filled in by individual proposing development)
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Signature
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print or Type Name
Telephone Numbe-
Date: p ��

07/30/01 07:35 FAX [phone] CLIFTON PLUMBING
Jul 30 01 08:02a Julian Dickens 553-6051
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