28837_HENRY, REITH & BETH_20010814

LAMA and DREDGE AND FILL
� G E N E R A L 29,837
PERM I T
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 t , : c;
Applicant Name Phone Number
Address
City State Nt zip _ 6Sf
Project Location (County, State Road, Water Body, etc.) �' f� ► ` ? r r1� f �u :r; -
• !r :•"1, ,,ter �c�•
Type of Project Activity
and attached general and specitic conaitions. Any violation or tnese terms applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void.This permit permit must be on the project site and accessible to the permit of- permit officer's signature
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 issuing date expiration date
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. attachments
In issuing this permit the State of North Carolina certifies that this project -P i
is consistent with the North Carolina Coastal Management Program. application fee

ERIC B. ELLIS NCDL 65047 2010
JASA M ELLIS PH(252)726-6775
205 NOTTINGHAM DR. / O 66-30/531
MOREHEAD CITY, NC 28557 Date gj 133
Pay to the .s�J/���
Order of l� /I/ $ 160, �
11/✓ ,�p—F /cam' Dollars
%IRS'TCITIZENS-
13AN K All— 2851
CITIZENS -
First CIlizons Bank 8TrusCompany Qgst
Fia Boaeh,N.C. t
Fo�� o?�
':0 5 3 100 3001:00 13 1 7448 780II1 0 20 10
GUARDIAN® SAFETY BLUE ESB

ADJACENT REPARLAN PROPERTY O WNTR STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to/Vr is
(Name of PropertyOwner)
property located at G 3
(Lot, Block, Road, et6.)
on , in f%67T f !L ��4c . f , N.C.
(Waterbody) (Town and/or County)
He has described to me, as s1hown below, the development he is proposing at tia: location,
and, I have no objections to his proposal. I understand that a pie -;mooring
pilings/boadift/boathouse must be se: back a minimum distance of fifteen fe:t (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 t.at setback re^uirernent.
DESCRIPTION AND/OR DRAWr G OF PROPOSED DEVELOPtitEti-I:
(To be filled in by individual proposing development)
Signature
/?/ " . z A L- 7 ',� /- N IJ
Print or Type Name
251- '% 2 �/, 4-- g2 S 21-
Telephone Number
Date: --,/ — 2 7 — C> f

l'
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Ow er)
Property located at
(Lot, Block, Road, etc.)
on -~ H C lac N , in /� f % �. r����' , N.C.
(Waterbody) (Town and/or County)
He has described to me, as s*:own below, the development he is proposing at t; at location,
and, I have no objections to his proposal. I understand that a pie-; mooring
pilings/boadift/boathouse must be se: back a minimum distance of fifteen feet (15') fron my area
of riparian access unless waived by me.
I do not wish to ware the setback requirement.
I jL wish to waive t ..at setback recuirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPMENT:
(To be filled irz by individual proposing development)
IY�
Signature
Print or Type Name
25 Z - 2 yo - -Z22
Telephone Number
Date: 7//5% 6 /