28910_GALLOWAY, DAVID_20010831

tit
CAMA and DREDGE AND FILL
I�
G E N E R A L S,910
PER
MI T
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
Applicant Name Phone Number
Address
City State Zip i
Project Location (County, State Road, Water Body, etc.)_
Type of Project Activity
l "I
PROJECT DESCRIPTION SKETCH __:;_.
(SCALE:
!
)
Pier (dock) LengthIt
�w
Groin Length I 1 i
_
_
number )
v
Bulkhead Length
max. distance offshore
_
,i
Basin, channel dimensions t• �•' t
cubic yards
.c
Boat ramp dimensions 4
Other
Ct5
. i_
.. ..
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.
applicant's signature
permit officer's signature
issuing date +. expiration date
attachments
application fee

a
THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH TOP AND BOTTOM
�rmmmmnn
NOT VALID OVER $1,000.00
ISSUING BRANCH `'s"T i'1 ;r`i.F w.ri C':i. •_,5, P•:ti. f, 61006547
DATE E=1'1i3::.F l.:i" 7 iI(:;::. 93-541/920
PAY TO THEr
ORDER OF (_,, .. ! „:.�L..i
�
TWO HUNDRED DGLLAF•S AND t:l(') CEP!'I``.S
DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
gB&T AND OTHER TERMS ON THEE REVERSE SIDE.
DRAWER: TRAVELLERS EXPRESS COMPANY, INC. �W"L 1`�_ _L_� !'ll�Js✓ J f AF
P.O. BOX 9476, MINNEAPOLIS. MN 65480 HA ER. Sill FOR DRAWER
DRAWEE: FIRST INTERSTATE BANK, HELENA, MT �• .A
ADDRESS
an s 'Tnie
1ING L006547110 1:09200541, 0:0 1,707 L045 L09 2111
■ THIS DOCUMENT HAS AN ARTIFICIAL. WATERMARK PRINTED ON THE BACK. 171E FRONT OF TI IE DOCUMENT HAS A MICRO-PRIN"ISIGNATURE LINE AND BORDER. ABSENCE OF TH65E FEATURES WILL INDICATE A COPY. ■

(FOR A PIERI UN k'-- O VEILED BOAT L I °T
I hereby ce; iry that t own property adjac:r, to 'D G AL C-PW R � Is
of Property O wmer;
proper-,y located ai_ 136 CNN I--VF T;—> `D_(1
(Lot, Block, RoL d, etc.)
on (Yj:A 0 MA E 41ZI(E�ps suq-p o , ?ti . C .
(Waterbody) (Town andlor� County)
He has desc: bed to me, as shown be o'w , ie Ceve:or ,ie.^.: nc is propcsi;.'z a= a:
Iocztion, and, I h'ay. no objec-ticris to i is proposes:. a pienluncovered boat lit:
must be set back a minimum distance of n�.e--n ft:et (:5') r,-cm, my,a,:ea or riparian acc--ss unless
waived by .me.
I do not wish to waive t e setback re.- irernen,- b
1 do u: is to waive that setback : ec a �r tent.
-------_------- (-._--------_----------------------------------
aESC- � , 0--P',;;OPOSFD--DE tiELOp'v=-N-':
o he ,.:.red is b: iadidual rc P osirz des; ei.opmen:)
Ct-
a
P9° Q Lf*�
Pr : or Type
T el ^.C[It
Dat
t>
�� 44 ,
le

IT,-,
T_ _ CEMENT
Aj
y ,
(FOR A PIER/UtYCOVCRED 130AT LEI
I hereby certify that I own. property adjac:.n: to ��_tl lh
�.e of Property Owner)
property located at 1 3 (a(Z-
lj r
(Lot, Block, Road, etc.)
on SAP M 141) L\, it
(Waterbodv) (Town ands or County)
He has described to me, as shown below, the development he. is proposing at that
location, and, I have no obje--dons to his proposal. understand (;hat a pier/uncovered 'boat lif,
must be set back a m-;rnimum distance of fifteen fee,, (:.5') from my area or riparian ac- ss unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback reauir-2rnent.
DESCRIP ON A-ND/OR DRA'WD G OF PRO POSEDjDEVELOPMENT. o
(To be felled in by individual proposing devetppmerzt)
73
Te phone Number
Data: 0AZ