27963_FAW, GARY_20010426

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CAMA and DREDGE AND FILL 27963--,"
G E N E R A L �,r I Ku.
PERM I T
as authorized by the State of North Carolina �oV
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 t
PROJECT DESCRIPTION SKETCH
(SCALE:
Pier (dock) Length
77
Groin Length - T
S
9
—
number(
Bulkhead Length
max. distance offshore
Basin, channel dimensions
<
r
cubic yards
c
t
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<
i
Boat ramp dimensions
Other
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7—
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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 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

MICHELF D. FAW NCDL 5148252
GARY FAW
103 WATER'S EDGE DR. PH. 919-223-6970
NEWPORT, NC 28570
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66-7538/2531 3267
DATE � c�f//` o/
FIRST FLIGHT
FEDERAL CREDIT UNION
1208 E. MAIN ST.
P HAVELOCK, NORTH CAROLINA 28532
FOR 9 - 1�6�4'tI:253L7 384i: L0800926 5 501' 3 28 7
$1a0. o0
DOLLARS B�

ADJACENT RLPARLAN, PROPERTY OWNTR STATEME-NT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shlown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier; mooring
pags/boa dfi/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.
R I dj4 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPME\'T:
(To be filled in by individual proposing development)
i
Signature
W
Print or Type Name
(0qq
Telephone Number
Date: -a- O

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ADJACENT RIPA.RL-ii PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to �z's
(Name of Property Owner)
property located at G Z, ?,c 'D ,
(Lot, Block, Road, etc.)
on % sz , in AU/zcy��/�T� N.C.
(Waterbody) (Town and/or County)
He has described to me, as s1hown below, the development he is proposing at tha-, location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boadift/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 wa:v'- the setback requirement.
_ I d-Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPN ENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
— �) ;,3 —6--1 9`6
Telephone Number
Date: �� 1 0 /

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