25075_HERTFORD COUNTY SOUTHERN RD WATER DISTRICT_20000612

CAMA and DREDGE AND FILL
G E N E R A L z r 0175
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PERMIT �JUL���
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
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) Length
Groin Length
i
number
Bulkhead Length a i
r
max. distance offshore mm
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
i-
i::= U± -, I J
k
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