28116_HARRIS, JOHN_20010716

{l7A
CAMA and DREDGE AND FILL
G E N E R A L
PERMIT `=
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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
State zip
and attached general and specitic conditions. Any violation of tnese 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.
IM :.
�i applicant's signature
1
1 permit officer's signature
1 • )vt. 1 (ta
issuing date expiration date
attachments
application fee

p�8118-+Pa 'Bc1 Sir WE
I.LG iD�iA � ��' j f. \ �; r / .�� 1538
3r,K, lPSCOIT .001 HERS. INC .r > r�>�'
rJ . 141 TARA TRL \r ` �. '�i, �'� j �f �\ l \r
N f�� ARAPAHOE NC 28510 , ��' l/�r�%�% �%� 66 30/531
f`\l \ �NX DATE v ��` 47,
PAY f���'����r lNj �f
TO THE
',ORDER OF
� DOLLARS
FYR -r CITIZENS v1
FirstCillzens Bank Company fIl ! �
Beyb oNC 29515 �•'����
IVP
'XI Nr�r� fir` ,, f r� �I N �;;���r`\;�, .,:,X�
00.L 5 38ii i.0,5 3 L001001:004 �7 L L0 2 54 29u `/,. fir,, ,\ ,�,r:f��

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIF (BOATHOUSE)
J v n D OCA -v- Ls 9
I hereby certify that I own property adjacent to 13c4ilo .i�, Ci ����rri 's
(Name of Property Owner)
property located at
10 D S (!A. s-,�iCCcY�I� 'D `' h%
(Lot, Block, Road, etc.)
'10 Ser:n K(e 29t6o
2�2r 3�'. z3�tU
on F-4r' fe. (cl (- a-C V) o L{ r, in ��c{ J � n �v, , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that Iocation,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatliftlboathouse 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 d-Q wish to waive that setback requirement.
---------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOMEENT:
(To be filled in by individual proposing development)
�d9 IY)5 l a j' Zr
SLAaAec' area
J
1
1-:�< te',de')
7-aPec- � 1 25057"
DOC k
�Ine i I
i E
Signature
& / 0145� J : 01AIE,4L
Printo?03—
r Type Name
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OW i ER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
-BoTloGrat G H av1riS
I hereby certify that I own property adjacent to -JO � Y-�- D H Q-Y, r I S ,s
(Name of Property Owner)
property located at 10 0 'D r ,
(Lot, Block, Road, etc.)
on r� r r }n t'e l c( 14 0r 60LA , in C f ny ey- , 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/boadiftiboathouse 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.
V I " wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-J>T?E:D Q / A(G7 1";,) 5%aC4ed coca
4 .
JU
v
b' 1 �C�C-
y 3 v l (.4 h'-ot .
.P,redq;A 9 rna �
g° beyY)d
�X ter.�feral
Lo t,V/ I Laf 4�d
1
Signat e
IN6-0�F /7�qZ /O P ✓y
Print or Type Name
Telephone Number
Date: