28166_FENTANA, BUDDY_20010716

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CAMA and DREDGE AND FILL
G E N E R A L''�
RMI'or
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
bd in an area of environmental concern pursuant to 15 NCAC r. '>'r-
Applicant Name
Address
Phone Number
City State Zip S :'
Project Location (County, State Road, Water Body, etc.) !r�e,' (�►�n�>> ,� 1 y ��a L-u 1r �� �c
of
Type of Project Activity
PROJECT DESCRIPTION SKETCH
(SCALE:
/vLiv`
)
Pier (dock) Length f r { i. ; ( „�„ .� € %
r, • , !
Groin Length
~
number �`
Bulkhead Length(, F
i F
max. distance offshore 1
6N
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rG� tr•�I
t
Basin, channel dimensions s V5
_ f..._.....:�, ?._... ._. �_..._.._....._
cubic yardsa_..l
_. _.,
M ;
Boat ramp dimensions I
Other
r
I
10±1
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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.
�xlJ
applicant's signature
t
permit officer's signature
issuing date expiration date
attachments
application fee

THIS MULTI -TONE AREA OF THE
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NOT VALID OVER $1,000.00� —
ISSUING BRANCH MHC MAIN/6102301 60177872
PAY TO THDATE July 17,2001 93-541/920
ORDER OFE------ ILLL_ } Q
***100.00*********
MIT . —�_ DOLLA BY SIGNING YOU AGREE To II IF SERVICE CIiARCf
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DRAWER: IHAVE LEIIS EXPRESS COMPANY, INI' C �I�"1'`\J
1'.O PDX 9475, MINNEAPOLIS, MN 55480 ---- - --�- �- � _ _ _ DHA -: FIRST INTERSTATE BANK, HELENA. M I PA�HSI -`- -- -- - -\ -
DRAWER
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11'601?787211, 1:092005411i:017071045109211■
■ THIS DOCUMENTHAS AN ARTIFICIAL WA"I'ERMARK PRINTED ON l'HE: BACK. 'I"HE FRONTOF'I'f IF DOCUMENT HAS A MIUtU ITIN I SIC:NA TURF LINE AND BURDI;R. ABSENCE OF'I'HF,SF: FFA'IURF"_4 WILL INDICATE A COPY. ■

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1 . 61. \.a WNJI� R SS'� �� ~ i •INN: aN .i
(FOR A PIERIUNCOBRED BOA T Lf �T• ^�GL
I hereby certify that I own prope—, ! adjacent to 's
(tii�me of Property Omer)
property located atl"g-[3
�T(L -ot, Block, Road, etc.) '
on ��PL� N.C.
(iYaterbody) (TO n and/orFCounty)
He has desc:-ibed to me, as shown below, the development he. ;.s proposing at that
location, ard, I have no o01 ons to his proposal. I understand at a pie; -/uncovered lift
must be set back a minimum distance of rite` fn fit (15') from my urea of r:par u ss
waived by me.
Zpp1
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRLT'" (DN' A,-ND/OR DR..A.VyTvG OF PRO POSED. DEVEL...OP_-Nff-N'T:
(To be filled in bv irzddvulzccl proposing deve11)pment)
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--- ------ --------------------
Signature
Print or Type Name
Telephone Numb('r
Dares:
3�

7-Ji5;(J(2iDp-I- ►J C 2�570
aSa SF3q - 343 �,
4

ry
iiv JL fine - 1-1i A'
(FOR A PIERIUNC-0VERED BOAT LiIF7) LL
I hereby certify that I own property adiac,�nt to ,n'&I- f A's
(�:�nie of Property Owner)
property located at Xore3
(Lot, Block, Road, etc.)
on r >Jl— , to --,_/l1 e " , N.C.
(W'aterbody) (Town and/or) Count )
He has desc;-,bed to me, as shown below, the developr'nent he is proposing at that
location, and, I have no obje~tions to his proposal. I understand at a pier/uncovered boat lir<
must be set back a minimum distance of fifteen feet (11.5') frcn my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement. �
AL 1 5 2001
I do wish to waive that setback requirement.
------------------------------- t--------- r fJHt KIMD------
DES CRE7VON -A-N-D/OR DRAWZEiG OF PRO POSED,DEVELOP-lyiE.�-I:
(To be ) lled in by individual proposing development)
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ab
I CY
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FC>Pr + Signature
Print or Type Najme
Telephone Numb r
Date: P/