27069_GREEN, CHARLES_20001228

CAMA and DREDGE AND FILL (9/ c
G E N E R A L P%� �, ; rC,
PE R M I T Gwsa- Tlzz i�
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 rv1 ._ r,tffr Phone Number "';� `%3'• 11�Fi�
Address _ i Y;; i'� r^c• w 'J Lr'
'P
City ' f1 tl State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
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.
F applicant's signature
1 (4
permit officer's signature
issuing date
expiration date
attachments
application fee

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U.S. DOLLARS AND `CENTS
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ADJACENT R)PA2 (kx `'Tp,(:t Ty 04� .� S1'A'7'g.Zr1
l hereby ccrtify t&.'t p ty adjacent
(Name of ftPP0Ffv 0-vncr)
ply located at
(Ltjt, .$10ck, Road, etc.)
on
own and/or• d-
He has dew w ine, as shown below, the dcvelopn;4,,t Fie .s I)raposing at that
location, "d, Y haves "*,rj to his proposal. T understand i "At a pperrisicovered ixat lift
must be set bask a diitance of fifteen fect (151) from my arPA,•,.L1parian acczss imless
waived by me.
wa: ve the setback requirement.
I C *love that srxbark requirement.
Y 4' /©R I)RAWING OF PROPOSE r; <<:,�' ,�,�➢x' �� in
f e be,
n
Vp
. proposing devs%p s}
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i
v o
I signature
N1
Print or Type Name
f cpho . Number

A ; AC '7, R)PA k-,T : `�,(:tpERTY 0,A-, ,,R St'A'EVi
��Tx ..� .4 .''fNwtrrr�G'c7vEREn �'3.A41
I hereby certify tt,: t I �);-M
(Naas of
ProPerty io=ed at
Ut, .$Zack, Road,
on
(Town and/or Oat xtp)
He has d+eu 61-A )0 Jie, as shown below, the de veloptc;k:;nt Y,e >.s pra;*sing at that
location, L4 I ha-W. ; tj moons to his proposal. I underglMd i , t 3 �b?6"e/1eYiCC3vCrCd brat lift
must be set bark a °� � � z�n dii rrce of fifteen feet (15') from my arPR>,, :;Parian arsess ienless
waived by me,
r.'j waive the setback requirement.
I � c -Wdve that setback requirement.
"/®R I) RAWING OF PROPOSE �K,�� ��.�_D r:
0 he ,mod in by individual proposing
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\ u/.V. /7enCY(er-sor�
'�, t or T�►pe Na�ie
7
t,Tcphone
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Number --
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