26956_FULCHER, CHRIS_20001003

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CAMA and DREDGE AND FILL
G E N E R A L
P E R M I T
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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.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
'\X
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.
zip
(SCALE: I )
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
application fee

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PRESCOTT BROTHERS INC
141 TARA TRL
ARAPAHOE, NC 28510
PAY
TO THE
ORDER OF
1344
66-30/531
DATE 471
I $ 2 ad
DOLLARS M"o 't° u"
FYAR�S1"T CITIZENS 411
V ' 1� �I Fi,-zens Bank 8 T-1 Company
Baybol%.N.C. 29515
11800 L344ii' i:053 L003001:0047 i l0 254 29n'

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to 's
me of Property Owner)
property located at Z-- `ftq /"C�
(Lot, Block, Road, etc.)
on Al'y(:"devi �/� .Q , in ��G � C, , 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
pilingslboatlift/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 d4 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
ri
Print or Type Name
21� z -z ?-- l3 (-
Telephone Number
Date: 0 � `� / , O LIW

ADJACENT RIPARIAN PROPERTY OWNER STATMENT
(FOR A PIE&MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to tll�.7 � Z� Is
(Name of Property Owner)
property located at
(Lot, Block, Road, a .)
on `,�vil� (;ll��� , in 9 �� 7i , N.C.
(Waterbody) (Town and/or C nty)
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 da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
F-aw), k 5
Print or Type Name
1;'�- 2qq- 1'� I �
Telephone Number
Date: 'I — I-s —C) C J