25699_GILLIKIN, JOHN_20001002

CAMA and DREDGE AND FILL_`
G E N E R A L �'.
F, n . I t`>, n, H
PERM I T _
as authorized by the State of North Carolina ��� "ff T (i%OZ ! y.
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address
City
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
cubic yards
Boat ramp dimensions
Other
Phone Number ""? "`'
State Zip
c
r < - '- ! (SCALE: H � l- r- )
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

ERIC B. ELLIS NCDL 65047 JASA M ELLIS PH(252)726-6775 1820
205 NOrfINGHAM DR.
MOREHEAD C,r Y, NC . 28557 Date 66-30/531
133
Pay to the y
Order of
ad0, o0
FIRST CITIZENS,b
Ti A I�TfI FlrgLyBmm BrN. N.C.
Trust Company
Fo
IM S 3 100 3001:00 13 17448 7BOu'
011320
GUARDIAN®SAFM BLUE ESBL

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ''siz�,c/ �,�� ; ti 's
(Name of Property Owner)
property located at
b ixJ-C !L/
(Lot, Block, Road, etc.)
on / ii : t '� �/,I,/ ; � .�, - �-, , 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
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 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Qo
hom 14 s
Signature
Print or Type Name
Telephone (Number
Date: 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ��'' ��/ ,',y 's
(Name of Property Owner)
property located at S�d a E' Al
(Lot, Block, Road, etc.)
on ,va , in ,'r"07".d�.e��1-4 ,�� l�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
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.
1,' I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
t 'y_
�K
SignatDIE
�%,n► mod► ✓ 1
Print or Type Name
gp8S 3 2;L6 V/�
Telephone Number
Date: / h D c7

MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PEFlv=E' S NAME: oM AP & W i K Al PERMIT # 24 I T —C
LOCATION: 12-1 aowe K S'G FIELD REP.
A+14 " f',
PHONE: 3U 5 T 8 5Yo 5
DATE REPORTEDLY COMPLETE:
y+-.f cvF� �/zSior
1) Do the sured dimensions of the development differ from those indicated in the permit and workplat?
YES O circle one].
COMMENT:
2) SEDIMENTATION OSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized
all disturbed areas? C9NO [circle one]
COMMENT:
3) FUTURE MONITOR ENFORCEMENT ACTION: Is further investigation or enforcement
action needed? YES O cle one].
COMMENT: