28176_KING, VICTOR_20010724

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CAMA and DREDGE AND FILL
.t G E N E R A L
%il�r f i
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 1
Applicant Name Phone Number
Address
City State zip
Project Location (County, State Road, Water Body, etc.) ;
i •ty �rt.Ii ,� l
Type of Project Activity
PROJECT DESCRIPTION SKETCH
(SCALE:
A4
)
Pier (dock) Length 41,
r J... ...
Groin Length to - Fi 1 i yt, `.1
number
Bulkhead Length �ry .
V V
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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r
i
Other
b—
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£ d,
try
This permit is subject to compliance with this application, site drawing i (� e,JAU
and attached general and specific conditions. Any violation of these 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.Lf�/'
This 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
is consistent with the North Carolina Coastal Management Program. application fee

THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH TOP AND BOTTOM
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NOT VALID OVER $1,000.91102301 MHC Main 6 0177898
ISSUING BRANCH 1
DATE / _ Q 99-541/920
PAY TO THE 1
�`} **100.00**
ORDER OF
RR .P T T DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
AND OTHER TERMS ON THE REVERSE SIDE.
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DRAWER: TRAVELERS EXPRESS COMPANY, INC.—��PURCHQ$C$IGNER FOR DRAWER
P.O. BOX 9476, TRAVELERS
MINNEPOLIS.EXPRESS
S COMPANY.
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55480
DRAWEE FIRST
RAWEE;FIRST INTERSTATE BANK, HELENA,, MTGD PC
fCI? t 'ENg- V, rI CIE
112601771391111" 1:092005L,111:OL7071045L09211'
0 THIS DOCUMENT HAS AN ARTIFICIAL WATERMARK PRINTED ON THE BACK. THE FRONT OF THE DOCUMENT HAS AMICRO-PRINT SIGNATURE LINE AND BORDER. ABSENCE OF THESE FEATURES WILL INDICATE A COPY. ■

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��t•1, � R �_ �� .'3JT�:11 `( X a ' ! �� .S.::s � � �. \J� J� ' .,� i .t:��
(FOR A PIER1L"N�COVERED B'OA7 LIM)
I hereby certify that I own property adiacent to6 s
(Ni,!ime of Property 0 saner)
ro r-ry located at
M
P Pe - -
(Lot, Block, Road, etc.)
on jnj:�_rj CAtJft �n N.C.
�Waterbody) (Town and/orl County)
He has descl-ibed to me, as shown below, the developrnernt he. is proposing, at that
location, a,.d, I have no objev ons to his proposal. I understand tphat a pies: -/uncovered boat lir
must be set back a minimum distance or" rzf e`n fit (15') from. my urea of riparian amass unless
waived by me.
I do riot wish to waive the setback requirement.
waive that setl:ack requirement. �UL Z 2001
I do wish to au .
MANAGEME
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DESCR(D?', kNM/OR DRA.V,LtiG OF PROPOSED'DEV
(To be flUed in by individual proposing deveL{)prneIZt)
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200�
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Signature
P,RLG
Print or Type Name
9-5"2- —7 a (o s9 0
Telephone Number
Date: j 3 �--

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(FOR A PIERIL'NCOVERED BOAT L'IFI)
I hereby c;..:ify that I own proper y adjacent to 's
(Mime of Pro rty er)
propery located at
Block, Road, etc.)
---. -- C' ,% N.C..
(W aterbody} (Town and/or) County)
He has described to me, as shown below, the developr!ipent he i.s proposing at that
location, ar.d, 1 have no objections to his proposal. I understand Pat a pie: -/uncovered boat lift
must be set back a minimum distance of rzf een fit (15') from. myarea of rparian acczss uniess
waived b e. -
°D
I do not wish to waive the sciback requirerne:it.
JUL 2 4 2001
I do wish to waive that setback requirement.
-------------------------------- --
DESCR=ON A-N-DOOR DRAVY-E iG OF PRO POSED'. DEVEI.OPNIEN-T:
(To be felled in by in-dividual proposing deveLf �pmerzt)
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i
e 4 ern � P L
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Signature
Print or Type Naane
Telephone Number
Date: `

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